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COUNTY OF SAN JOAQUIN <br /> Date: -26-261-;S <br /> DEPARTMENT OF PULIC WORKS <br /> J <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#:(f)c-1 <br /> k APPLICANT OFFICE USE ONLY <br /> Name. e <br /> Address:—1 G L C JOB#: 11005 ISSUE DATE: <br /> City, State,Zip Code: GC_ ; APN dpS�/SG_r'� FEE DUE: <br /> Area Code -Telephone Number:3c)C/—S t J V;V7 `/ EXP. DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: <br /> QUAD <br /> Parcel Owner's Name: TYPE: <br /> Site Address: FORMS: <br /> City,State,Zip Code: C q Y� U NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> - CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: <br /> Address: AGRICULTURE: @FRONTAGE <br /> 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 /> The undersigned hereby applies for permission toxcavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> to6V A side of E vv, ,0-sll �Z0�1 approximately feetlmiletQq_*!S <br /> of W 4251' , by installing � <br /> commence on or aboutWork will <br /> for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> ,Will this project be self-installed? YESNO <br /> Contractor's License <br /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 1 of 2 <br />