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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#:�L( <br /> APPLICANT OFFICE USE ONLY <br /> Name: FVVjL1Cil <br /> Address: – *< JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code. Nom. RPM- C A APNy��--(,�'1j--�� FEE DUE: <br /> Area Code -Telephone Number: 70 ,. 7 Z, EXP.DATE: DRIVEWAYS: <br /> STREET: .. <br /> SITE INFORMATION: AREA: QUAD <br /> Parcel Owner's Name: ( TYPE: �, <br /> Site Address: 1$�� Al. FORMS: <br /> City, State,Zip Code: Lo ct M4 Z_ NOTES: <br /> Area Code -Telephone Number: p — 3 to <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: TZA2 .0 COMMERCIAL: <br /> City, State,Zip Code-.S "A CA qlrq6=-�_ INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: `_ RESIDENCE: <br /> AL Re t4Afi`bS0'kJ PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> F The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> L,U"T side oty>1 VVC.,a 4 9ci.&LKeh approximately 2000 feet/ rk o2't-1�.- <br /> of VX) , ,by installing A rU&%ju b aiy,6 <br /> -&Mro--A Jule I-0 'M*& W <br /> Work will <br /> commence on or about for approximately (.O �`-1�_days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License 771670 <br /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 of 2 <br />