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COUNTY OF SAN JOAQUIN Date: F_.2.2— 2' <br /> DEPARTMENT OF PULIC WORKS _ <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: "IANni PA JOB#: 11005 ISSUE DATE: ,_� .tj <br /> City,State,Zip Code: 1 ) APN Cc ;v —ilq FEE DUE: <br /> Area Code -Telephone Number. EXP.DATE: - DRIVEWAYS: <br /> STREET: � ,�-� K,Ck <br /> SITE INFORMATION: AREA: , QUAD W <br /> Parcel Owner's Name: i TYPE: 1 c4 � <br /> Site Address: FORMS: N(A-1 t <br /> City,State,Zip Code: �,� NOTES: <br /> Area Code -Telephone Numbe : ;I I� <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 applies for permission to expavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> side of approximately —` � c feet/mile )c(S+- <br /> of `c`C�w� J ,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 NO Contractor's License <br /> I\SJPWGOV.ORG%SHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 1 of 2 <br />