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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />PS- <br />'LIDIIctj <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />I <br />APPLICANT <br />Name: 7 <br />-co <br />Address: D Pv Ji.O(JA-CLF <br />City, State, Zip Code: <br />o CIL oN Z <br />Area Code - Telephone <br />Number: <br />Email: <br />AREA: C1_n� <br />cJhOLZ . (OKA <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />ORMS: s <br />F/ <br />Sw W r -nndL� <br />o o <br />Site Address: 2 <br />Uf <br />D L;jnl <br />City, State, Zip Code: S <br />< C - o 2 <br />Area Code - Tele hone <br />Number: r <br />CONTRACTOR <br />Name: <br />Address: <br />City, State, Zip Code: <br />COMMERCIAL: <br />Area Code -Telephone <br />Number: <br />I <br />The undersigned <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN OSb--700—LS <br />FEE DUE: <br />EXP, DATE: <br />DRIVEWAYS: <br />STREET: 90.20 <br />F.1:LA,Aar Rpse &LAI <br />AREA: C1_n� <br />1•.� n QUAD <br />—' <br />TYPE: <br />pW APcfrR <br />ORMS: s <br />F/ <br />Sw W r -nndL� <br />NOTES: <br />, by installing <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />16FRONTAGE <br />AGRICULTURE: <br />COMMERCIAL: <br />INDUSTRIAL: <br />RMI <br />RESIDENCE: <br />/ <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: Ft. <br />The undersigned <br />hereby <br />applies for permission <br />to excavate, <br />construct and/or otherwise encroach on Counly Hi <br />way Right-oT-Way on the <br />sideofa <br />40i SG <br />64e <br />approximately Ld75 <br />e <br />{milts CPGAS-f <br />of <br />fio <br />+ c Owl <br />F <br />, by installing <br />commence on or about <br />for approximately <br />days. <br />Work will <br />Will this project beself-installed? 'V YES NO Contractor's License ��c .N1 � U I✓ ^/�2 <br />X'ENgtOROHMEMSNaslm Forms-Tertpklea�ENORMCMA£M PERAYi ORNEWRV dao (aBNB) <br />