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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />OFFICE USE ONLY <br />Name: le Cv i <br />Address: 42 1&741 LL ✓E <br />11005 ISSUE DATE: <br />Cit , State, Zip Code; Xr <br />yrs Z L <br />Area Code - Telephone Number: <br />4/ny <br />Email: Cvj ff Lr <br />lG <br />SITE INFORMATION: <br />QUAD AW <br />Parcel Owner's Name: L% <br />ZY✓ ¢OracrL <br />Site Address: Y Glut; 491f k <br />I✓�.1� /� <br />City, State, Zip Code: ei'i6s l <br />t Z <br />Area Code -Telephone Number: 9-60 <br />-711V4P <br />CONTRACTOR <br />QUANTITY <br />Name: <br />AGRICULTURE: <br />Address: <br />COMMERCIAL: <br />City, State, Zip Code: <br />RNV <br />Area Code -Telephone Number: <br />K <br />Date: Z Z I ZZ <br />Received By: <br />cR#: .473701 <br />Th$ undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Hi ay Right -of -Way on the <br />/ side of G//6A9,(' leo, approximately O e ile �A� <br />of .446& f .CD , by installing <br />commence on or about <br />SKETCH (Separate sheet may be <br />Will this project be self -installed? YES NO <br />XENMOAOHMEM@ tw Fa=Jert bWTNCROACHWW PERMR NNEWAY h (") <br />for approximately <br />Contractor's License <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN <br />t7Y„3-OSO-/9 FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />�✓V <br />AREA: <br />QUAD AW <br />TYPE: <br />ZY✓ ¢OracrL <br />FORMS:» <br />I✓�.1� /� <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />I @FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />RNV <br />RESIDENCE; <br />K <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH; Ft. <br />Th$ undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Hi ay Right -of -Way on the <br />/ side of G//6A9,(' leo, approximately O e ile �A� <br />of .446& f .CD , by installing <br />commence on or about <br />SKETCH (Separate sheet may be <br />Will this project be self -installed? YES NO <br />XENMOAOHMEM@ tw Fa=Jert bWTNCROACHWW PERMR NNEWAY h (") <br />for approximately <br />Contractor's License <br />days. <br />Work will <br />