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I <br />til <br />El <br />-F251 2:�o 31143 <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Name: 17,41AW 10 6AAe— +A <br />Address: 1&24 6 <br />City, State, Zip Code: ' Z&O <br />Area Code - Telephone Numbe <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />Site Address: 092.7- f T <br />City, State, Zip Code: <br />Area Code - Tele hone Numb r: <br />CONTRACTOR <br />Name: tZr7ttrJZV A9062nf7Z- <br />Address-- <br />City, State, Zip Code: <br />Area Code - Telephone Number: <br />Date: li 3o ± <br />Received By: 01 <br />CR#: x,9969 <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feet/mile <br />NJ <br />commence on or about <br />SKETCH (Separate sheet may be <br />Will this project be self -installed? /J) YES NO <br />PI NCNOACHMEWMsW Fam% aWhlul NCHOACHMEM PMW DWMAY*c(00) <br />by installing <br />for approximately <br />Contractor's License <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN Doff- <br />98o FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: 3i. <br />a.+ pct, <br />AREA: <br />QUAD <br />TYPE: �✓ <br />FORMS: 5b <br />-!-1 <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />RNV <br />RESIDENCE: <br />K <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: Ft. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feet/mile <br />NJ <br />commence on or about <br />SKETCH (Separate sheet may be <br />Will this project be self -installed? /J) YES NO <br />PI NCNOACHMEWMsW Fam% aWhlul NCHOACHMEM PMW DWMAY*c(00) <br />by installing <br />for approximately <br />Contractor's License <br />days. <br />Work will <br />