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COUNTY OF SAN JOAQUIN Date: o /9 1'3 <br /> ' DEPARTMENT OF PULIC WORKS 1302?�� Received By: � <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> APPLICANT OFFICE USE ONLY <br /> Name: ':zm <br /> � Address: � v Z JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: ' G _ �,� APN /5'9- D-t> FEE DUE: <br /> Area Code -Telephone Number. 2 ' 'o EXP. DATE: DRIVEWAYS: <br /> STREET: -�Pfu165 X06e. <br /> SITE INFORMATION: AREA: QUAD <br /> Parcel Owner's Name: - TYPE: 94) - 2 <br /> Site Address: G S" v FORMS: -l7 <br /> I <br /> City, State,Zi Code. rtf�;-� eO- `�S `LLs NOTES: <br /> Area Code -Telephone Number: I-6 7 <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: NoNt= <br /> AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RJW <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby appll'e�for permission to excavate,construct and/or otherwise encroach on County Hi hway Right- Way on the <br /> �r4 S side of C'uu y/�- tt: AK approximately fe ifc� <br /> of 4 "M/ 157. by installing �'Yi nes <br /> o - <br /> oe <br /> j0 Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? _Z-- YES NO Contractor's License <br /> 1lSJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKWASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 of 2 <br />