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:!5-2ool oeq <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Name: C641 <br />a <br />ta% <br />r 50v, <br />Address: 16475 S, i de <br />DRIVEWAYS: <br />City, State, Zip Cade: , eh <br />C-4 q57366 <br />Area Code -Telephone Number: <br />,2IPon/ QUAD 59 ' <br />204 4-Z8' S <br />SITE INFORMATION: <br />Parcel Owner's Name: 6k& <br />v I :f » <br />Site Address: l A &17 S f. e Rif , <br />City, State, Zip Code: o" <br />0} gS366 <br />Area Code - Telephone <br />Number: <br />209 <br />968= 6 3 <br />WIDTHS <br />CONTRACTOR <br />AGRICULTURE: <br />Name: CRcutnr, <br />dti <br />Address: X6055 S, T <br />City, State, Zip Code: ^A95366 <br />INDUSTRIAL: <br />Area Code - Tele hone Number: <br />2tlit 465 63W <br />Date: 24 Z6 <br />Received By: 9G� <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Hi way Right -of -Way on the <br />side of approximately l so fe ile 5oE- r- A <br />Of vxck CAw o • by installing dnv2wa4 o�oe� <br />wont wm <br />commence on or about J✓t o 17. <br />15?•fJ for approximately days. <br />SKETCH (Separate sheet may be submitted) <br />CoeVJ <br />� \ <br />�r Imo, <br />ao' <br />Will this project beself-installed? YES NO Contractor's License <br />P:1ENCfl0ACHMENTSWasler FamisTemgaleslENCftOACNMENT PENMR OflNEWAY.4oc10&BB7 <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN 203-/00-/7 FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />T/pe ,ed. <br />AREA: <br />,2IPon/ QUAD 59 ' <br />TYPE: <br />X>M/ <br />FORMS: <br />ss wi/ k1-7 <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />I @FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />A RIW <br />RESIDENCE: <br />d' <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 way Right -of -Way on the <br />side of approximately l so fe ile 5oE- r- A <br />Of vxck CAw o • by installing dnv2wa4 o�oe� <br />wont wm <br />commence on or about J✓t o 17. <br />15?•fJ for approximately days. <br />SKETCH (Separate sheet may be submitted) <br />CoeVJ <br />� \ <br />�r Imo, <br />ao' <br />Will this project beself-installed? YES NO Contractor's License <br />P:1ENCfl0ACHMENTSWasler FamisTemgaleslENCftOACNMENT PENMR OflNEWAY.4oc10&BB7 <br />