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a Ra <br />COUNTY OF SAN JOAQUIN <br />PS -220111$ DEPARTMENT OFPULICWORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />I <br />•n <br />Date: 414 1 20.2 <br />Received By: 2*Q, <br />#_. <br />APPLICANT <br />Name: <br />11005 ISSUE DATE: <br />0 <br />FEE DUE: <br />VI I <br />EXP. DATE: <br />Address: <br />STREET: 5%C <br />A A -a H <br />City, State, Zip Code: <br />MzAAtQZ <br />9 S3 3 7 <br />Area Code -Tele <br />hone <br />Number: <br />U9 <br />-.✓E J/jj-11 <br />2'iS-11 <br />NOTES: <br />Email: <br />DRIVEWAY <br />('fl <br />TYPE: <br />QUANTITY <br />1 <br />. ftnl <br />AGRICULTURE: <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />0 <br />COMMERCIAL: <br />0 <br />VI 0 <br />Site Address: <br />5 <br />NDUSTRIAL: <br />a <br />a <br />City, State, Zi Code: <br />VAL <br />S22 <br />Area Code - Tele hone <br />Numbe : 09 <br />&111 <br />CONTRACTOR <br />Ft, X WIDTH: <br />Name: <br />Ft. <br />Address: <br />City, State, Zi Code: <br />Area Code - Telephone <br />Number: <br />I <br />•n <br />Date: 414 1 20.2 <br />Received By: 2*Q, <br />#_. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Ri h -of-Way on the <br />I. side of _ Ai -e m R4 approximately do 750 ile <br />of van, &V lr-k , by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />See Al AG�,e l <br />Will this project be self -installed? <br />YES NO <br />XIENCROACHNEMSINaskr FamsimpH�`ENpiWCHMEIRPERMRORfYEWAT doo�O&g0) <br />for approximately <br />Contractor's License <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN 011-X20-16 <br />FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: 5%C <br />A A -a H <br />AREA: Ao <br />„ AR QUAD <br />TYPE: <br />Aooroac� <br />_DW <br />FORMS: S5 <br />-.✓E J/jj-11 <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />FRONTAGE <br />COMMERCIAL: <br />NDUSTRIAL: <br />RM <br />RESIDENCE: <br />VAL <br />PAVED <br />FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: <br />Ft. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Ri h -of-Way on the <br />I. side of _ Ai -e m R4 approximately do 750 ile <br />of van, &V lr-k , by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />See Al AG�,e l <br />Will this project be self -installed? <br />YES NO <br />XIENCROACHNEMSINaskr FamsimpH�`ENpiWCHMEIRPERMRORfYEWAT doo�O&g0) <br />for approximately <br />Contractor's License <br />days. <br />Work will <br />