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COUNTY OF SAN JOAQUIN Date: t1- 1-2aG3 <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND AND PAVED FRONTAGES <br /> �Oq 32n - yo d ! PERMIT APPLICATION CR#: U <br /> APPLICANT OFFICE USE ONLY <br /> Name: o - <br /> Address: F0 JOB#: 11005 ISSUE DATE: <br /> City, State,Zip Code: CAIA I Cj -Z APN c�Z�,-C> _,�c� FEE DUE: <br /> Area Code -Telephone Number: 2 o -,goe EXP. DATE: _ DRIVEWAYS: <br /> STREET: , ,r <br /> SITE INFORMATION: AREA: QUAD 1= <br /> Parcel Owner's Name: ,� TYPE: <br /> Site Address: RJ FORMS: ss <br /> City,State,Zip Code: CA NOTES: <br /> Area Code -Telephone Number: 20,q - `Z -gu <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: Sq„ Svc e� AGRICULTURE: 1 @FRONTAGE <br /> Address: O 80,lcS COMMERCIAL: <br /> City, State,Zip Code: •�I I4 INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: 20q- 3 1-?::VO 0 17 RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby appliPG fnr nPrmission excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> 5tA I-L^=side of �., �� � approximately �, Chn;xc^�e ( 0nile <br /> of tc-vtt aa� ,by installing <br /> commence on or about for approximately days. Work will <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 />