Permits & Development - Encroachment(EP)/Driveway(DW) Permits-2022_Driveway Permits_PS-2200501 thru PS-2201000_-PS-2200813

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COUNTY OF SAN JOAQUIN Date: _ DEPARTMENT OF PULIC WORKS Received By: DRIVEWAYS AND PAVED FRONTAGES PERMIT APPLICATION APPLICANT OFFICE USE ONLY Name: JOB #: 11005 ISSUE DATE: Address: c N c r— Nc Cit ,Slate, Code: csti _ c t e I 2' c-�) Area Code - Tele one Number:' .c Z- t O 7 JO Email: 7k ov CZci Od.E_c SITE INFORMATION: Parcel Owner's Name: )y e c n Site Address: 'Z. rc FORMS: City, State, Zip C e: G c�Area Code - Telephone Number: CONTRACTOR TYPE: Name: Address: AGRICULTURE: City, State, Zip Code: I @FRONTAGE Area Code - Telephone Number: The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the side of approximately feet/mile of by installing commence on or about SKETCH (Separate sheet may be submitted) for approximately Will this project be self -installed? _YES NO Contractor's License %.1ENCROACHMEMSIMaaler Forma-iamplaleelENtROACHMENi PERMIT �RIVEWAYtlool0Bl00) days. Work will OFFICE USE ONLY JOB #: 11005 ISSUE DATE: APN FEE DUE: EXP. DATE: DRIVEWAYS: STREET: AREA: QUAD TYPE: FORMS: NOTES: DRIVEWAY TYPE: QUANTITY WIDTHS AGRICULTURE: I @FRONTAGE COMMERCIAL: INDUSTRIAL: RfW RESIDENCE: PAVED FRONTAGE LENGTH: Ft. X WIDTH: Ft. The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the side of approximately feet/mile of by installing commence on or about SKETCH (Separate sheet may be submitted) for approximately Will this project be self -installed? _YES NO Contractor's License %.1ENCROACHMEMSIMaaler Forma-iamplaleelENtROACHMENi PERMIT �RIVEWAYtlool0Bl00) days. Work will