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COUNTY OF SAN JOAQUIN Date: Y 10-S '20 lFz, <br /> \� DEPARTMENT OF PULIC WORKS <br /> Received By:r --�- <br /> �� DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: ©clq-$�7 <br /> b ` `� M,Q, e. \z <br /> APPLICANT OFFICE USE ONLY <br /> Name: dr7,` , - <br /> Address: ' ,Z c JOB#: 11005 ISSUE DATE: <br /> City,State,Zi Code: APN 1 2�Z-uav-c-t l FEE DUE: <br /> Area Code -Tele hone Number: c3 , ,<?c,15 EXP.DATE: DRIVEWAYS: <br /> STREET: VzW G <br /> SITE INFORMATION: AREA: \ QUAD.S <br /> Parcel Owner's Name: TYPE: Dv\J e a s <br /> ' Site Address: Sc, ti'z FORMS: SSS 1 <br /> 1 <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY. <br /> -- -- - <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 excavate,construct and/or otherwise encroach on County Hi hway ight-of-Way on the <br /> approximately Z.?r, e t/mile <br /> of l by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> 7�Will this project be self-installed? _\__YES NO Contractor's License <br /> M:ICENTRALSERVICESICLERICAL\PUB-SV.WMMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />