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COUNTY OF SAN JOAQUIN Z (0 370 2 Date: I k 6)2 <br />DEPARTMENT OF PULIC WORKS <br />Received By: 1 C <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION CRA <br />APPLICANT <br />OFFICE USE ONLY <br />Name: <br />JOB #: 11005 ISSUE DATE: <br />APN l q 3 n FEE DUE: <br />EXP. DATE: o DRIVEWAYS: <br />STREET: ,,0Ak <br />AREA: MI QUAD Al <br />TYPE: <br />FORMS: wir+ - <br />NOTES: <br />DRIVEWAY <br />Address i5bff <br />TYPE: <br />QUANTITY <br />City, State, Zip Cod <br />CR Q1,5231 <br />Area Code Telephone <br />Number: <br />WIDTHS <br />SITE INFORMATION: <br />Parcel <br />Owner's <br />Name: 3.05Z 1 e5P5 <br />Site Address: 4 C isbet Ln <br />Ci State ZI Code:Ic- <br />C 3 <br />Area Code <br />- Tele <br />hone <br />Number: <br />) UID— b(62 <br />CONTRACTOR <br />Name: <br />Address: <br />City, State, Zip Code: <br />Area Code <br />-Telephone <br />Number: <br />The untlers[gned hereby applies for permissioq to excavate, consUuct and/or otherwise encroach on County Highway Right -of -Way on the <br />Fron FF side of i alt road approximately IO F feetimile <br />of t=risbee L%10a bylnstallinp Cone✓t DriyiwGf <br />Work will <br />coMill ence on or about $ 2 for approximatey 3i7 days. <br />(Separate sheet maybe <br />�Zngd <br />Fr1Z)Dc <br />LQ Y) e <br />enkvance <br />f C�a�1e l <br />Ica FT �ss <br />WIII this project beself-installed? ✓ YES NO <br />P�EIICRCACNMEIITSVhMu fwmsTerrygieSEtICROACHMEM PERNIi RRNfWAY.Ow 108981 <br />Contractor's License <br />T <br />LO <br />Enkr0.rt CP <br />L-�gfie <br />1 L FT <br />OFFICE USE ONLY <br />JOB #: 11005 ISSUE DATE: <br />APN l q 3 n FEE DUE: <br />EXP. DATE: o DRIVEWAYS: <br />STREET: ,,0Ak <br />AREA: MI QUAD Al <br />TYPE: <br />FORMS: wir+ - <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />I @FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />@ R/W <br />RESIDENCE: <br />iz JK <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: <br />Ft. <br />The untlers[gned hereby applies for permissioq to excavate, consUuct and/or otherwise encroach on County Highway Right -of -Way on the <br />Fron FF side of i alt road approximately IO F feetimile <br />of t=risbee L%10a bylnstallinp Cone✓t DriyiwGf <br />Work will <br />coMill ence on or about $ 2 for approximatey 3i7 days. <br />(Separate sheet maybe <br />�Zngd <br />Fr1Z)Dc <br />LQ Y) e <br />enkvance <br />f C�a�1e l <br />Ica FT �ss <br />WIII this project beself-installed? ✓ YES NO <br />P�EIICRCACNMEIITSVhMu fwmsTerrygieSEtICROACHMEM PERNIi RRNfWAY.Ow 108981 <br />Contractor's License <br />T <br />LO <br />Enkr0.rt CP <br />L-�gfie <br />1 L FT <br />