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• COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> D VEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#:_ q6 <br /> APPLICANT OFFICE USE ONLY <br /> Name:( 4vi/\ Mc <br /> Address: 75 ��. ;�- e JOB#: 11005 ISSUE DATE: <br /> City, State,Zip Code: Cpr f APN FEE DUE: <br /> Area Code -Telephone Number: 2Lxy-- 527--�57�;�1 EXP. DATE: DRIVEWAYS: <br /> STREET: '�• ��( �� ((�}t,,} 0 J_ <br /> SITE INFORMATION: AREA: QUAD t <br /> Parcel Owner's Name: ���, .� _ ( TYPE: Ww)g ,,- <br /> Site Address: ", (,-.v�u,i►1��� �Zc:r FORMS: <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number. �cq <br /> DRIVEWAY <br /> CO RACTOR TYPE: QUANTITY WIDTHS <br /> Name: -& VW, • AGRICULTURE: @FRONTAGE <br /> Address: f-/ c —? COMMERCIAL: <br /> City,State,Zip Code: = C% INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: - ^ac — r RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby aes for perms ion to excaviconstruct and/or otherwise encroach on County Highway Right-of-Way on the <br /> side of 'Cl�.tZW jLow, approximately f et/mile Sou <br /> of 56 itu"25 ,by installing �� <br /> Y Work will <br /> commence on or about i I V L5TJ t-J for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> LAM <br /> F1 <br /> Will this project be self-installed? YES _ NO Contractor's License 1 7 <br /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 1 of 2 <br />