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�s-2ioo%7 <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />Date: 6 L, <br />Received By: <br />CR#: 070%92 <br />APPLICANT <br />Name: <br />ff y <br />APN <br />Address: <br />�✓ <br />Cif , State, ZI Code: <br />r <br />9Mi <br />Area Code -Telephone <br />Number: o S _ <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />0 <br />vtt0k. <br />Site Address: <br />c <br />City, State, Zip <br />Code: <br />Area Code - Tele hone <br />Number: <br />CONTRA 0 <br />Name: <br />WIDTHS <br />Address: <br />AGRICULTURE: <br />City, State, Zip <br />Code: <br />Area Code - Telephone <br />Number: <br />COMMERCIAL: <br />Date: 6 L, <br />Received By: <br />CR#: 070%92 <br />The ntlersigned hereby applies or permission to excavate, construct andlor otherwise encroach on County H g ay Right- f-Wa on the <br />AST side of awe cw approximately o fe mile <br />Of #V Gil. , by installing <br />commence on or <br />SKETCH (Separate sheet may be submitted) <br />Will this project be self -Installed? ZY <br />ES NO <br />P.�£NCROACHMENfSIWsls Rmm-TemgaleSFNCROACNMENi PERMN RRNEWAYGoc(UBgO) <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 />pr,/� FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />TJa <br />AREA: <br />QUAD & <br />TYPE: <br />Q}n! <br />FORMS: <br />µryAea /7 <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />I @FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />C R/W <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. <br />X WIDTH: <br />Ft. <br />The ntlersigned hereby applies or permission to excavate, construct andlor otherwise encroach on County H g ay Right- f-Wa on the <br />AST side of awe cw approximately o fe mile <br />Of #V Gil. , by installing <br />commence on or <br />SKETCH (Separate sheet may be submitted) <br />Will this project be self -Installed? ZY <br />ES NO <br />P.�£NCROACHMENfSIWsls Rmm-TemgaleSFNCROACNMENi PERMN RRNEWAYGoc(UBgO) <br />for approximately <br />Contractor's License <br />days. <br />Work will <br />