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PS- 2200641 <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />17 71�/�44e\�1e1� Ul �e\�l �7yii7��fseC�3�� <br />PERMIT APPLICATION <br />APPLICANT <br />OFFICE USE ONLY <br />Name: <br />11005 ISSUE DATE: <br />APN log -tD0-2S <br />FEE DUE: <br />:7 <br />DRIVEWAYS: <br />Address: <br />A NIP <br />s e <br />City, State, Zip Code: ,v1 >1 c <br />5 3 <br />Area Code -Telephone Number: Z — 6 5Ci <br />Prn a6t <br />Email: <br />NOTES: <br />y 61 it 4y yk"W� lZow <br />SITE INFORMATION: <br />Parcel Owner's <br />Name: <br />S <br />WIDTHS <br />Site Address: <br />City, State, Zip Code: <br />Area Code <br />- <br />Telephone Number: <br />CONTRACTOR <br />Name: HckLujS <br />c,Y4� �v <br />Address: <br />Cit , State, Zi Code: <br />Area Code -Tele <br />hone <br />Number: <br />@ RIW <br />Date: 1/29112 <br />Received By: 3(4- <br />CR#:013718 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Hi hway Right -of -Way on the <br />4A. tk, sideof Louisa. A„e approximately 4.r,Au He Woct! <br />of Jai It 70., a R A, , by installing <br />commence on or <br />may <br />for approximately <br />Will this project be self-inslalled7 YES �_NO Contractor's License <br />%�ENgiMgIMENiSMaslx FamsiwrpbinlENCRMCHNEMPERIAt URNEYRYdao(OBpB) <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB M <br />11005 ISSUE DATE: <br />APN log -tD0-2S <br />FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: 12162 <br />F. Ln,wisG pve <br />AREA: MAn <br />Ve e Q QUAD <br />TYPE: 11V Qp <br />Prn a6t <br />FORMS: SS-uw/2_tl <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />@ RIW <br />RESIDENCE: <br />/ <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: Ft. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Hi hway Right -of -Way on the <br />4A. tk, sideof Louisa. A„e approximately 4.r,Au He Woct! <br />of Jai It 70., a R A, , by installing <br />commence on or <br />may <br />for approximately <br />Will this project be self-inslalled7 YES �_NO Contractor's License <br />%�ENgiMgIMENiSMaslx FamsiwrpbinlENCRMCHNEMPERIAt URNEYRYdao(OBpB) <br />days. <br />Work will <br />