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COUNTY OF SAN JOAQUIN Date: /3 <br /> DEPARTMENT OF PULIC WORKS <br /> xwe( v�AO DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> L-e)d ��, PERMIT APPLICATION CR#:_M9 9 <br /> Name: <br /> APPLICANT OFFICE USE ONLY <br /> � :- <br /> Address: / ^�/;d�� /Y JOB#: 11005 ISSUE DATE: <br /> City, State,Zip Code: "SA 0 S 3 APN DS, -1 � — FEE DUE: <br /> Area Code -Telephone Number:�c - - _- 3 EXP.DATE: DRIVEWAYS: <br /> STREET: 444,9 <br /> SITE INFORMATION: AREA: oz)/ QUAD A-IV <br /> Parcel Owner's Name: rilvv''' e-L (,c. io TYPE: <br /> Site Address: z c,e)o �-v 14-- +e( wy;,ti, C FORMS: 7 <br /> City,State,Zip Code: l-e) .L`, CZ I. NOTES: <br /> Area Code -Telephone Number: ?-o - z:F <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: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby appll*pj for permission to pxcavate construct and/or otherwise encroach on County H' way Right-of-Wa on the <br /> �,4� side of approximately 700 fe mile <br /> of ,G�/✓1 � , , 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-installe ? i YES a NO Contractor's License <br /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 1 of 2 <br />