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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />PS-2Do3830 <br />Date: )2w w <br />Received By: <br />GW <br />cR#: 0 700y 7 <br />APPLICANT <br />Name: <br />11005 ISSUE DATE: <br />Address: 3 b 1 6 <br />5 <br />PsCA AN rel <br />EXP. DATE: <br />City, State, Zip Code: <br />Q A C <br />S o <br />Area Coe -Tele hone <br />tuber: <br />1. <br />9 <br />"(leo 4Q <br />SITE INFORMATION: <br />CAcck.. <br />Parcel Owner's Name: <br />Ar N r t_ <br />A <br />Site Address: <br />3 Lr LL6 C AkZ e <br />City, State, Zip Code:3 <br />DRIVEWAY <br />Area Code - Tele hone <br />Number: rA <br />;t T,;9r7r7 <br />QUANTITY <br />CONTRACTOR <br />WIDTHS <br />Name: <br />AGRICULTURE: <br />Address: <br />I <br />@FRONTAGE <br />Cit , State, Zi Code: <br />COMMERCIAL: <br />Area Code - Telephone <br />Number: <br />Date: )2w w <br />Received By: <br />GW <br />cR#: 0 700y 7 <br />The undersigned hereby applies for permission t excavate, construct andlor otherwise encroach on County Hi ay Right-of-Wa on the <br />ly&gcxT� side of , `�^ 7 approximately e� lie <br />of I�ayD�u�/�I& AV cti , byinstalling Nei xL.; r � ruo � <br />commence on or about <br />may <br />Will this project be self -installed? ✓YES NO <br />P.IENCROACNMEMSMesMFmraTenpleleslENDRDACNMEM PEPIAITDRNPYAV Gs�L898) <br />for approximately <br />Contractor's License <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN <br />210- /a FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: ZIa4C6„ AD Cr <br />AREA: <br />QUAD 5aU <br />TYPE: �a <br />Afi�iQao4t,61 <br />FORMS: <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />I <br />@FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />RAN <br />RESIDENCE: <br />K <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: '' <br />�W — Ff. <br />The undersigned hereby applies for permission t excavate, construct andlor otherwise encroach on County Hi ay Right-of-Wa on the <br />ly&gcxT� side of , `�^ 7 approximately e� lie <br />of I�ayD�u�/�I& AV cti , byinstalling Nei xL.; r � ruo � <br />commence on or about <br />may <br />Will this project be self -installed? ✓YES NO <br />P.IENCROACNMEMSMesMFmraTenpleleslENDRDACNMEM PEPIAITDRNPYAV Gs�L898) <br />for approximately <br />Contractor's License <br />days. <br />Work will <br />