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t <br />x <br />Ci <br />COUNT Y OF SAN JOAQUIN Date: �`s"s4_ <br />DEPARTMENT OF PULIC WORKS <br />Received By; :► �= <br />DRI /EVVVAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Name: e crNi i ,, I <br />Address: ,' C' t 'a <br />City, State, Zip Code:Area Code Telephone Number: e <br />r <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />Site Address:(�,� 4 tu,.►,, <br />City, State, Zip Code: rA, tjamteclk ()A CIS - <br />-Area <br />Area Code - Telephone Number: <br />CONTRACTOR <br />Name: <br />Address: iA j, <br />City, State, Zip Code: ryi ruP <br />pip c t'� <br />Area Code - Telephone Number: — a <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the <br />_ side of approximately feetlmile <br />of , by installing _ <br />commence on or about <br />� SKETCH (Separate sheet may be submitted) <br />for approximately <br />Will this project be self-ir)stallE:d? AYES NO Contractor's License <br />P.IEWCROACHI✓ENTSUda4er PonnsdempleleslEIJCROACHMEhff PERAd� t1RIVEl1'AY.doo (OBI08) <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN 27.E J/6-zre <br />FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: vq"`} <br />12�po n t <br />AREA: A4av% tom QUAD 50J <br />TYPE: D, <br />pip c t'� <br />FORMS: <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />R/W <br />RESIDENCE: <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 Highway Right -of -Way on the <br />_ side of approximately feetlmile <br />of , by installing _ <br />commence on or about <br />� SKETCH (Separate sheet may be submitted) <br />for approximately <br />Will this project be self-ir)stallE:d? AYES NO Contractor's License <br />P.IEWCROACHI✓ENTSUda4er PonnsdempleleslEIJCROACHMEhff PERAd� t1RIVEl1'AY.doo (OBI08) <br />days. <br />Work will <br />