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ztoll(o9 <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />/PERMIT APPLICATION <br />45AfAZLSbt nuntP aw.r 1y 123@ya�ias,con� <br />APPLICANT <br />Name: \xto elUI <br />OS <br />Address: <br />12(0 22. E <br />r r) <br />Ltp3' fJ d% FEE DUE: <br />Cit , State, Zi Code: L06\ C,,A 45 0 <br />Area Code -Telephone Number: 2o9 • 4 <br />0 ll- 3 O <br />SITE INFORMATION: <br />Parcel Owner's Name: K c:)5 <br />Site Address: t210 c+rn <br />City, Stale, Zip Code: 1.(D Ck k CIA <br />J <br />D <br />Area Code - Telephone Number: 2L)q LI <br />01 o l <br />7)LO <br />CONTRACTOR <br />Name: <br />Address: <br />City, State, Zip Code: <br />Area Code - Telephone Number: <br />Date: 7 <br />Received By: <br />CR#: Z lli 9j 3a <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Hi ay Right -of -Way on the <br />SsurN side of MLfiRu6Y LN approximately %O a mile E9s i <br />of�by installing <br />commence on or <br />SKETCH (Separate sheet may be <br />for approximately <br />Will this project be self -installed? YES �NO Contractor's License <br />P.IENCROACNMENTSMevlx Famciemple4AENCRCACNMfNTPEflMIT flRIVEWAT dw�CB'O0� <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APIN <br />Ltp3' fJ d% FEE DUE: <br />EXP, DATE: <br />DRIVEWAYS: <br />STREET: <br />/,�t/. <br />AREA: <br />,oal QUAD f <br />TYPE: <br />7)LO <br />FORMS: <br />g-/7 <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />RM <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: <br />Ft. <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Hi ay Right -of -Way on the <br />SsurN side of MLfiRu6Y LN approximately %O a mile E9s i <br />of�by installing <br />commence on or <br />SKETCH (Separate sheet may be <br />for approximately <br />Will this project be self -installed? YES �NO Contractor's License <br />P.IENCROACNMENTSMevlx Famciemple4AENCRCACNMfNTPEflMIT flRIVEWAT dw�CB'O0� <br />days. <br />Work will <br />