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i .2lo3(9SS <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />Date: W.Lg l 9.D a <br />Received By: 3% <br />CR #: DIUSS <br />APPLICANT <br />Name:04y <br />11005 ISSUE DATE: <br />APN p63 <br />e/ <br />Address: ro <br />vc ) <br />h <br />City, State, Zip Code:q <br />STREET: 12 <br />(, > <br />Area Code -Telephone Number: <br />7� <br />z't S 3 to 9 <br />Email: i r <br />L. Wo d,,t <br />. N e <br />SITE INFORMATION: <br />FORMS: 58 <br />Parcel Owner's Name:{n1 <br />n r <br />v / 1 <br />Site Address: <br />I Z9zZ <br />Ad& G <br />City, State, Zip Code: <br />L cf C.4 <br />v —3 2 - <br />Area Code - Telephone <br />QUANTITY <br />Number: Lo 9 <br />2 • 99or <br />CONTRACTOR <br />AGRICULTURE: <br />Name: <br />@FRONTAGE <br />Address: <br />Lj <br />lbw <br />Ci" -,State State, Zi Code: <br />INDUSTRIAL: <br />Area Code - Telephone <br />Number: <br />@ <br />R/W <br />Date: W.Lg l 9.D a <br />Received By: 3% <br />CR #: DIUSS <br />The undersigned hereby appJ� s for perm' sion to exc te, construct andlor otherwise encroach on County H�i hway Right -of -Way on the <br />eow3r Lnj K t.A/• approximately IISe(fpMmile �y ! <br />of illiO77IcLLE GsV• by installing <br />commence on or <br />for approximately <br />days. <br />Work will <br />Will this project be self -installed? <br />KV:NLROALHMEMSMesMfwmaTertplalmlENCROACHMEIRPERIMONNEWAYdao(0&OBj <br />NO Contractor's License <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN p63 <br />-t Jp-DS FEE DUE: <br />EXP, DATE: <br />DRIVEWAYS: <br />STREET: 12 <br />-roL& k <br />L„ <br />AREA: L n <br />1 QUAD <br />TYPE: <br />AAOAVw�l! <br />FORMS: 58 <br />wwx I& I) <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />@ <br />R/W <br />RESIDENCE: <br />vod� <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: <br />Ft. <br />The undersigned hereby appJ� s for perm' sion to exc te, construct andlor otherwise encroach on County H�i hway Right -of -Way on the <br />eow3r Lnj K t.A/• approximately IISe(fpMmile �y ! <br />of illiO77IcLLE GsV• by installing <br />commence on or <br />for approximately <br />days. <br />Work will <br />Will this project be self -installed? <br />KV:NLROALHMEMSMesMfwmaTertplalmlENCROACHMEIRPERIMONNEWAYdao(0&OBj <br />NO Contractor's License <br />