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PS- ISO 0OLD 4 <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 />Name: Yr <br />11005 ISSUE DATE: <br />Addre s: <br />✓ <br />✓ <br />City, State, Zip Code: n/1 <br />STREET: S4 S_ <br />Area C e -Tele hone Num el <br />AREA: S}nr.lc}� <br />Email: W U i <br />TYPE: DW <br />SITE INF RMAT ON: <br />FORMS: SS/wwr <br />Parcel Owner's Name: G✓l C <br />Site Address: <br />Il•Z <br />City, State, Zip Code: U d,7 <br />D <br />Area Code - Tele hone Number: ODO <br />TYPE: <br />C NTRACTOR <br />QUANTITY <br />Name: J S d✓I <br />(/ <br />Address: /CJS / n <br />t <br />City, State, Zip Code: <br />4 <br />Area Code - Tele hone Number: <br />ry <br />407�iz <br />Date: 1126 2022 <br />Received By: 'tip <br />:0'7 3 S 34 <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the <br />Eµsk sideof T.1sA approximately 67-5 L-A He L%L <br />Of G$? &rnFOU5 , by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />days. <br />Work will <br />Will this project beself-installed? � YES NO <br />%'EIIgiWCNMEMSVMsIu FamsTe,rylelea�ENCRMCHMEM PEAlNI OItNFNAY.tloo(OBP9) <br />Contractor's License -13y �6 S <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN IDS -I10-11 <br />FEE DUE; <br />EXP, DATE: <br />DRIVEWAYS; <br />STREET: S4 S_ <br />TmIsA Ave <br />AREA: S}nr.lc}� <br />QUAD <br />TYPE: DW <br />AnnroAGl <br />FORMS: SS/wwr <br />R-1'7 <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE; <br />I <br />C&FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />RIW <br />RESIDENCE: <br />✓ <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: Ft. <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the <br />Eµsk sideof T.1sA approximately 67-5 L-A He L%L <br />Of G$? &rnFOU5 , by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />days. <br />Work will <br />Will this project beself-installed? � YES NO <br />%'EIIgiWCNMEMSVMsIu FamsTe,rylelea�ENCRMCHMEM PEAlNI OItNFNAY.tloo(OBP9) <br />Contractor's License -13y �6 S <br />