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PS -2103$7°1 <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />Date: 110d 2 0 Z 2 <br />Received By: 40 <br />CR#:013610 <br />APPL <br />ICA <br />T <br />11005 ISSUE DATE: <br />Name: <br />0 4D- 67 FEE DUE: <br />t�v D9 <br />L. <br />Address: '?6 & LJcrrS <br />Lucas 2d <br />City, State, Zip Code: <br />G r, <br />QUAD <br />9.5eL <br />'L <br />Area Code - Tele hone <br />Number: <br />FORMS: SSSS/ <br />Email: vNOVI <br />Nw Jci <br />s .c s, <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />Site Address: <br />LJ <br />QUANTITY <br />City, State, Zip Code: <br />CA <br />Z <br />Area Code - Tele <br />hone <br />Number: Z09 6o7015L <br />CONTRACTOR <br />Name: <br />Address: <br />City, State, Zip Code: <br />M <br />RESIDENCE: <br />Area Code - Telephone <br />Number: <br />Date: 110d 2 0 Z 2 <br />Received By: 40 <br />CR#:013610 <br />The undersigned hereby applied for permission ex vate, construct and/or othenraise encroach on County Highw�Right-of-Way on the <br />Sou Iu side of approximatelyfe mil <br />i <br />of celo^ by installing <br />Work will <br />commence on or about ✓cGt for approximately days. <br />(Separate sheet may be submitted) <br />Will this projectbe self•installerJ? YES NO Contractor's License <br />x��,�aoA�xxEMswa,�a, r��..&wa�a.,EHOROA�HMExrPEaM��oa��wa..aamaAa� <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN O IG- <br />0 4D- 67 FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />Lucas 2d <br />AREA: t a <br />QUAD <br />TYPE: <br />FORMS: SSSS/ <br />C-1 <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />A <br />INDUSTRIAL: <br />M <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: <br />Ft. <br />The undersigned hereby applied for permission ex vate, construct and/or othenraise encroach on County Highw�Right-of-Way on the <br />Sou Iu side of approximatelyfe mil <br />i <br />of celo^ by installing <br />Work will <br />commence on or about ✓cGt for approximately days. <br />(Separate sheet may be submitted) <br />Will this projectbe self•installerJ? YES NO Contractor's License <br />x��,�aoA�xxEMswa,�a, r��..&wa�a.,EHOROA�HMExrPEaM��oa��wa..aamaAa� <br />