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COUNTY OF SAN JOAQUIN Date: A <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: i <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: tel'#SCP1r�5 <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: 11 -j 1;c K e 6 -Rd JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: I-vd C/-1- 15)#lJ -9y9y APN FEE DUE: <br /> Area Code -Telephone Number: EXP.DATE: DRIVEWAYS: <br /> STREET: . let7. <br /> SITE INFORMATION: AREA: 1�� 8�D QUAD , <br /> Parcel Owner's Name: o c ,�c/ o,nnu,i TYPE: <br /> Site Address: I �j , �, FORMS: S t it v ) <br /> ' City,State,Zi Code: J or k NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY. <br /> - CONTRACTOR - -_- TYPE:- - - -,-- QUANTITY- - WIDTHS <br /> Name: ,Mrd_ (', tr4c to, <br /> _ C AGRICULTURE: @FRONTAGE <br /> Address: '3 ( I,)I&n r'c/ COMMERCIAL: <br /> City,State,Zip Code: S c)cC o,, C14 INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: A 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 Hi hway Right-of-Way on the <br /> r side of JACK 7'C Qp_ approximately &0e ite' SEx7F�1 <br /> of /LJAi2T l✓+4y by installing j>lJ• <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 /> M:ICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />