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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />Date: _11312 <br />Received By: it/ <br />CR#: %x7261 <br />APPLICANT <br />Name: <br />JOB #: <br />APN <br />EXP. DATE: <br />STREET: <br />AREA: <br />Address: <br />City, State, Zip Code: <br />Area Code -Telephone Number: 7 13!9 <br />SITE INFORMATION: <br />Parcel Owners Name; <br />TYPE: <br />LR✓ <br />Site Address: l 7 <br />/7 <br />City, State, Zip Code: <br />NOTES: <br />Area Code -Telephone <br />Number: <br />DRIVEWAY <br />CONTRACTOR <br />Name: <br />TYPE; <br />Address: <br />City, State, Zip Code: <br />Area Code -Telephone <br />Number: <br />Date: _11312 <br />Received By: it/ <br />CR#: %x7261 <br />The undersigned hereby applies for permisson to excavate construct andlor otherwise encroach on County Highway Right -of -Way on the <br />— !�A side of ri'Ill't? 2�L � proximately in g e feetlmile <br />of .pD, by installing <br />Work will <br />commence on or aboutP 2b Z_p for approximately ? (j days. <br />SKETCH (Separate sheet may <br />Will this project beself-installed? YES <br />P:MNCROACHIAEMSWasMr FamsiempletaslENCRCACHMFM PEHMR URNEWAY.dac(OeroB� <br />N 7 <br />Contractor's license � 3'4 7r � <br />OFFICE USE ONLY <br />JOB #: <br />APN <br />EXP. DATE: <br />STREET: <br />AREA: <br />11005 ISSUE DATE: <br />$+ //tO Xy FEE DUE: <br />_ DRIVEWAYS: <br />AW19 2- A04 <br />n1A4A/ QUAD "9 <br />TYPE: <br />LR✓ <br />FORMS: <br />/7 <br />NOTES: <br />DRIVEWAY <br />TYPE; <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />@ <br />RIW <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: <br />Ft. <br />The undersigned hereby applies for permisson to excavate construct andlor otherwise encroach on County Highway Right -of -Way on the <br />— !�A side of ri'Ill't? 2�L � proximately in g e feetlmile <br />of .pD, by installing <br />Work will <br />commence on or aboutP 2b Z_p for approximately ? (j days. <br />SKETCH (Separate sheet may <br />Will this project beself-installed? YES <br />P:MNCROACHIAEMSWasMr FamsiempletaslENCRCACHMFM PEHMR URNEWAY.dac(OeroB� <br />N 7 <br />Contractor's license � 3'4 7r � <br />