Laserfiche WebLink
, <br /> - COUNTY OF SAN JOAQUIN Date: 5 2 1 <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: :54� <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#:_ X2.3 Z� <br /> PPLI ANT OFFICE USE ONLY <br /> Name: d P 16 <br /> Address: )61 0 -7 p �"�,' . " �,.j JOB#: 11005 ISSUE DATE: _ <br /> City,State,Zip Code: � c c iAPN &;6S-/&44f_Z/ FEE DUE: <br /> Area Code -Telephone Number: ,a EXP.DATE: DRIVEWAYS: <br /> STREET: , <br /> SITE INFORMATION: AREA: QUAD <br /> QUAD <br /> Parcel Owner's Name: V d 1 4- TYPE: <br /> Site Address: 7.> t-- f-� -, ,,� j��,� FORMS. <br /> City, State,Zip Code: �, .u� �-�`? NOTES: <br /> Area Code -Telephone Number: C-l cf ►�"- v <�, <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City, State,Zip Code: INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> T e undersigned hereby appl' s for permission to excavate,construct and/or otherwise encroach on County LHighw6igAht-of;-Way on the <br /> side of Ai�AV,9Q ��. approximately <br /> of !/may „ J.r�t/ yt/ ,by installing AA✓ <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License <br /> 11SJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 1 of 2 <br />