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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />Date: S11012,( <br />Received By: l5cl. <br />CR#: oo&! <br />PPLICANT <br />Name: (/YaLZyvnt7 <br />JOB #: <br />Address: <br />City, State, Zip Code: <br />FEE DUE: <br />DRIVEWAYS: <br />Area Code - Telephone <br />Number: <br />SITE NFORMAT10NO <br />Parcel Owner's Name: <br />/ u O ✓° <br />Site Address: <br />a4 <br />City, State, Zip Code: <br />Area Code -Telephone <br />20 <br />Number: / 9 5 <br />CONTRACTOR <br />Name: <br />Address: <br />Cit, State, Zip Code: <br />Area Code - Telephone <br />Number: <br />Date: S11012,( <br />Received By: l5cl. <br />CR#: oo&! <br />The undersigned hereby applies missjon Jp axcavate, construct an or otherwise encroach on County Hi way Right -of -Way on the <br />L/ L.�- side of n 1 iQ approximately eo ee ile E <br />Of 4:�,Pa1=AW limp by installing <br />commence on or <br />for approximately <br />SKETCH (Separate sheet may be submitted) <br />1 <br />I <br />i' <br />I <br />I <br />1 <br />{1 ` <br />oach wrvl <br />I <br />I <br />Will this project be self -installed? NO <br />P�ENCROACHMENiSVAestx FwmaTei,plams�ENCROACHAFNt PERMR NRNEWAYtlro(0&OB) <br />Contractor's License <br />says. <br />WOrK WIII <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN <br />EXP. DATE: <br />FEE DUE: <br />DRIVEWAYS: <br />STREET: <br />AREA: <br />G , <br />e.& � ICS <br />0 QUAD M <br />TYPE: <br />D <br />FORMS: <br />.J <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />FRONTAGE <br />COMMERCIAL: <br />NDUSTRIAL: <br />R NV <br />RESIDENCE: <br />K <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: <br />Ftl <br />The undersigned hereby applies missjon Jp axcavate, construct an or otherwise encroach on County Hi way Right -of -Way on the <br />L/ L.�- side of n 1 iQ approximately eo ee ile E <br />Of 4:�,Pa1=AW limp by installing <br />commence on or <br />for approximately <br />SKETCH (Separate sheet may be submitted) <br />1 <br />I <br />i' <br />I <br />I <br />1 <br />{1 ` <br />oach wrvl <br />I <br />I <br />Will this project be self -installed? NO <br />P�ENCROACHMENiSVAestx FwmaTei,plams�ENCROACHAFNt PERMR NRNEWAYtlro(0&OB) <br />Contractor's License <br />says. <br />WOrK WIII <br />