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' COUNTY OF SAN JOAQUIN Date: "'��lo l <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION C #: L 7 <br /> APPLICANT OFFICE USE ONLY <br /> Name: G.Y. —rt-4o r-n ro rd <br /> Address: Z16 o S JOB#: 11005 _ ISSUE DATE: <br /> City, State,Zip Code: 5-IDC1Z-MtJ Cl,t-- APNS"SZ-64 FEE DUE: <br /> Area Code -Telephone Number: Z 3.5 — 1%,S7 EXP.DATE: DRIVEWAYS: <br /> STREET: Pwaijiftgi jZv% <br /> SITE INFORMATION: AREA: 5r7t cJcMZ QUAD <br /> Parcel Owner's Name: TYPE: P414 If <br /> Site Address: Z &4 p S. fICA.J y �'9 FORMS: MAJ <br /> 7- <br /> City,State,Zip Code: 01—oGic rmj CA- 17.5 Z/3 NOTES: <br /> Area Code -Telephone Number: Log— 2 Y -/1SJ <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RNV <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> T undersigned hereby applies for per <br /> ,[nission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> sideof 1WA-X,4r0f* AtDA-D approximately feet/mile <br /> of ,by installing <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 V-- NO Contractor's License <br /> IISJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 1 of 2 <br />