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a� 0602143 <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Name: "/N S NASD <br />Address: 0 44 Ab rq v <br />City, State, Zip Code: C W ZU <br />Area Code -Telephone Number: ?O L2 <br />SITE INFORMATION: <br />Parcel Owner's Name:6df1/ !y <br />Site Address: 6' C R <br />Cit , State, Zi Code l P — 3 <br />Area Code - Tele hone Number: ' <br />CONTRACTOR <br />Name: <br />Address: <br />City, State, Zip Code: <br />Area Code -Telephone Number: <br />Date: // — A9 — -,AO <br />Received ryByy: �✓ <br />CR#: //cam Y/ <br />Theundersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the <br />30uih/ side of approximately / feet/mile -it/l� <br />of by installing + /9 a/o sRV,40W <br />commence on or <br />SKETCH (Separate sheet may be submitted) <br />P�- <br />1 .9_ gx0Jc11 c�+,D 4ev � <br />Will this project be self -installed? V YES NO <br />PWJN CAGWENBWasNr For s-TIAs@NCROACHNEM PERMT OPNMAYdu)08M) <br />for <br />avo 9G (SA> <br />Contractor's License <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN !1 <br />j FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />NCAC,AAny 9D, <br />AREA: r"ocPggµp <br />QUAD S4 <br />TYPE: <br />AAPAMcAs <br />FORMS: <br />16- 17 <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />@ RNV <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: Ft. <br />Theundersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the <br />30uih/ side of approximately / feet/mile -it/l� <br />of by installing + /9 a/o sRV,40W <br />commence on or <br />SKETCH (Separate sheet may be submitted) <br />P�- <br />1 .9_ gx0Jc11 c�+,D 4ev � <br />Will this project be self -installed? V YES NO <br />PWJN CAGWENBWasNr For s-TIAs@NCROACHNEM PERMT OPNMAYdu)08M) <br />for <br />avo 9G (SA> <br />Contractor's License <br />Work will <br />