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# 7 <br /> ` COUNTY OF SAN JOAQUIN Date: _ <br /> c 7� <br /> '�C`) L' -7� ��' DEPARTMENT OF PULIC WORKS <br /> 2 U Qi —� Received By: .. ,�. <br /> k,11 <br /> -t J, �( DRIVEWAYS AND PAVED FRONTAGES y <br /> PERMIT APPLICATION CR#: C LI�SS� <br /> APPLICANT OFFICE USE ONLY <br /> Name: 1,-( '(�t� ► -L -- �, ��:� <br /> Address: 13' N. CT . JOB#: 11005 ISSUE DATE: <br /> City, State,Zip Code: Lupi CNq> y' APN "2. 2 - FEE DUE: <br /> Area Code -Telephone Number: lob q71-13, 9 EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: QUAD A(�-,Y` <br /> Parcel Owner's Name: SC-d6 2 TYPE: <br /> Site Address: 0(o2e? 14y_6oL)j2 4. FORMS: S Gil" <br /> City,State,Zip Code: -j-&x- Ch 4?S i 2- NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: -6c)iLocr 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 excavate,construct and/or otherwise encroach on County 24611mile <br /> hway Right-of-Way on the <br /> side of A� U.w L7�`U approximately '�� NLA-k v-,- <br /> of St,.._ e L"'n- by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> f <br /> Will this protect be self-installed? YES NO Contractor's License <br /> 11SJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10/09) Page 1 of 2 <br />