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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#: DW91�A <br /> APPLICANT OFFICE USE ONLY <br /> ,Name: //f n7 <br /> Address: / / JOB#: 11005 ISSUE DATE: <br /> City, State,Zip Code: ,,,;<1 C -A 9 S 36 APN p3.—/ U—O FEE DUE: <br /> Area Code -Telephone Number: C EXP.DATE: DRIVEWAYS: <br /> STREET: '.?�. f * <br /> SITE INFORMATION: AREA: . pn QUAD : <br /> Parcel Owner's Name: 6 6,d i i,,,d f'r1,0 TYPE: <br /> Site Address: /7.5�9Z )b Allis k>. FORMS: !��✓ -t <br /> City,State,Zip Code: c a 7 5.?Z o NOTES: <br /> Area Code -Telephone Number: 209 57 - ,160 <br /> �— <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: eG/ <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Th and signed hereby appliesfor ermission to excavate,construct and/or otherwise encroach on County Hi ay Right-of-Way on the <br /> side of o approximately fe �t�T <br /> of v� ,by installing ?�i✓i <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 /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 1 of 2 <br />