Laserfiche WebLink
z Zoo I Z <br />COUNTY OF SAN JOAQUIN Date: '. <br />DEPARTMENT OF PULIC WORKS <br />Received By: <br />DRIVEWAYS AND PAVED FRONTAGES <br />p <br />i r�-Nn��`i PERMIT APPLICATION <br />h�.rrs�(�,A <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feeumile <br />Of by installing <br />commence on or about <br />for approximately <br />days. <br />SKETCH (Separ e s,�eet a�ubmittetl) <br />(rte. �1 <br />(� `'te��� °� tie <br />Will this project be self -installed? YES NO <br />Contractor's License <br />P:IENCPOAGHMENTSNIasior TamsiomplaleslENCROAGNMEMPEPMiTPPIVEWAY.tlac (08108( <br />Work will <br />APPLICANT <br />JOB #: <br />Name: ' o > <br />p^ <br />APN Qi <br />Address: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />City, State, Zip Code: <br />AREA: <br />v <br />TYPE: <br />Area Code - Telephone <br />Number:209 42 -.539 <br />70 <br />SITE INFORMATION: <br />Parcel <br />Owner's Name: <br />o�)( <br />DRIVEWAY <br />rC <br />Site Address:Code: <br />QUANTITY <br />U <br />n 310'2 <br />City, State, Zi <br />AGRICULTURE: <br />C <br />@FRONTAGE <br />COMMERCIAL: <br />Area Code Telephone <br />Number: <br />a <br />CONTRACTOR <br />RIW <br />Name: <br />Address: <br />PAVED FRONTAGE <br />City, State, Zip Code: <br />Ft. X WIDTH: <br />Area Code - Telephone <br />Number: <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feeumile <br />Of by installing <br />commence on or about <br />for approximately <br />days. <br />SKETCH (Separ e s,�eet a�ubmittetl) <br />(rte. �1 <br />(� `'te��� °� tie <br />Will this project be self -installed? YES NO <br />Contractor's License <br />P:IENCPOAGHMENTSNIasior TamsiomplaleslENCROAGNMEMPEPMiTPPIVEWAY.tlac (08108( <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN Qi <br />7 3 j % FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />AREA: <br />QUAD <br />TYPE: <br />FORMS: <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />RIW <br />RESIDENCE: <br />PAVED 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 Right -of -Way on the <br />side of approximately feeumile <br />Of by installing <br />commence on or about <br />for approximately <br />days. <br />SKETCH (Separ e s,�eet a�ubmittetl) <br />(rte. �1 <br />(� `'te��� °� tie <br />Will this project be self -installed? YES NO <br />Contractor's License <br />P:IENCPOAGHMENTSNIasior TamsiomplaleslENCROAGNMEMPEPMiTPPIVEWAY.tlac (08108( <br />Work will <br />