Laserfiche WebLink
COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />Date: � <br />Received By: :!Z <br />APPLICANT <br />Name: <br />e <br />!ry¢p QUAD M' <br />wx -/7 <br />zaj <br />Address:lotmaw <br />TYPE: <br />W• ka <br />City, State, Zip Code: <br />►F %9L'10 <br />Area Code - Telephone <br />AGRICULTURE: <br />Number: 1L <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />„j" <br />Site Address: 1101p <br />M, S C <br />City, State, Zip Code: <br />2 <br />0 RIW <br />Area Code - Tele <br />hone <br />Number: Zp <br />PAVED FRONTAGE <br />CONTRACTOR <br />Name: <br />Address: <br />City, State, Zip Code: <br />Area Code - Tele hone <br />Number: <br />2'1,4 <br />Date: � <br />Received By: :!Z <br />The and�(signed hereby applies for pe mission t9 excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the <br />DYi�t side of 1jr4m 1f /Za( approximately. ig C%eflmile EMrf <br />of fj by installing�10 <br />Work will <br />commence on or a ou toD for approximately 7 days. <br />SKETCH (Separate sheet may be submitt <br />ed) <br />0 <br />Will this project be self -installed? YES �NO <br />P:IENCROACHMENiSAks�er Forms-Temgales�ENCROACHMEMPERI.IIi ORNEWAV.La (09NB� <br />Contractor's License <br />OFFICE USE ONLY <br />JOB M 11005 ISSUE DATE: <br />APN FEE DUE: <br />EXP. DATE: DRIVEWAYS: <br />STREET: %WrMr RD* <br />AREA: <br />TYPE: <br />FORMS: <br />NOTES: <br />!ry¢p QUAD M' <br />wx -/7 <br />zaj <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />0 RIW <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: Ft. <br />The and�(signed hereby applies for pe mission t9 excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the <br />DYi�t side of 1jr4m 1f /Za( approximately. ig C%eflmile EMrf <br />of fj by installing�10 <br />Work will <br />commence on or a ou toD for approximately 7 days. <br />SKETCH (Separate sheet may be submitt <br />ed) <br />0 <br />Will this project be self -installed? YES �NO <br />P:IENCROACHMENiSAks�er Forms-Temgales�ENCROACHMEMPERI.IIi ORNEWAV.La (09NB� <br />Contractor's License <br />