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A <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APNORW FEE DUE: <br />Address: Q <br />O l'id <br />DRIVEWAYS: <br />y , <br />"o <br />City, State, Zi Code: C Az- , <br />CA Ci <br />zic <br />Area Code - Telephone Number. r <br />E <br />' Y <br />Email: (fit <br />r L c2 i <br />c <br />rj)AA <br />SITE INFORMATION: <br />Parcel Owner's Name: L u �4 <br />DRIVEWAY <br />w %z <br />Site Address: I y' v '* <br />�j1 e <br />tti 4O <br />City, State, Zip Code: 5 c;<Av, <br />ii <br />zZ(A- <br />Area Code -Telephone Number:'L+rCI) <br />vw ' <br />3 3 i g <br />COMMERCIAL: <br />CONTRACTOR <br />INDUSTRIAL: <br />Name: <br />@ <br />RIW <br />P. <br />Address: <br />City, State, Zip Code: <br />PAVED FRONTAGE <br />Area Code -Telephone <br />Number: <br />LENGTH: <br />Date: 1'e 1 <br />Received By: <br />The undersigned hereby applies for permission fo excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feeurnue <br />Of by installing <br />Work will <br />commence on or about for approximately days. <br />�` Will this project be self -installed? YES NO <br />X�ENCROACHMEM51Mas�er FmmsTeirylaleslENCROACHNENi PERMR RPIVEWAY da (ABNB) <br />Contractor's license <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APNORW 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 />@ <br />RIW <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: <br />Ft. <br />The undersigned hereby applies for permission fo excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feeurnue <br />Of by installing <br />Work will <br />commence on or about for approximately days. <br />�` Will this project be self -installed? YES NO <br />X�ENCROACHMEM51Mas�er FmmsTeirylaleslENCROACHNENi PERMR RPIVEWAY da (ABNB) <br />Contractor's license <br />