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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />Date: t w 10L1 <br />Received By: lk <br />CR #: 013D I S <br />OFFICE <br />AP ICANT <br />Name: <br />1 <br />EXP. DATE: DRIVEWAYS: <br />STREET: Z Lg7y S Mpn �o me Rel <br />Address: 6 <br />Q <br />FORMS: 17' <br />Cit ,State, Zi Code: <br />(J <br />L <br />TYPE: <br />Area Code - Telephone <br />Number: <br />Od' <br />Email: <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />A <br />i �4• <br />Site Address: <br />t 0 <br />q <br />p. <br />City, State, Zip Code: <br />J <br />E @+ <br />A <br />Area Code -Telephone <br />Number: <br />RNV <br />CONTRACTOR <br />Name: <br />� <br />Address:U <br />rr <br />City, <br />State, Zip Code: <br />Area Code - Telephone <br />Number: <br />1 <br />00, 9 <br />Date: t w 10L1 <br />Received By: lk <br />CR #: 013D I S <br />OFFICE <br />USE ONLY <br />JOB #: 11005 ISSUE DATE: <br />APN ►5 FEE DUE: <br />EXP. DATE: DRIVEWAYS: <br />STREET: Z Lg7y S Mpn �o me Rel <br />AREA: QUAD <br />TYPE: ac! <br />FORMS: 17' <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />I @FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />RNV <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: Ft, X WIDTH: Ft. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Hic ay Righ -of-Way on the <br />9'F side of .NN.vThcr9 .eD approximately a ile 471" <br />of 4ems aD- AA"rw4e^ , by installing <br />commence on or about <br />for approximately <br />SKETCH (Separate sheet may be submitted) <br />IT\ <br />Will this project be self -installed? YES NO Contractor's License <br />X1FNp20FCNMENfSlNaln FamsTarybka�ENGiMCHMEM PEx*Yr ORNEWAY.tloo (OBN81 <br />days. <br />Work will <br />