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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />y PERMIT APPLICATION <br />Date; <br />Received By; <br />APPLICANT <br />JOB #: <br />Name: NC -n l" <br />APN <br />Address: eiV,. <br />EXP. DATE: <br />City, State, Zip Code: <br />,� �� 1\ <br />ck s' <br />` <br />Area Code - Telephone <br />Number: L,iQ R' .iV S°" C <br />2. g fir` <br />SITE <br />INFORMATION: <br />NOTES: <br />Parcel Owner's Name: <br />'3 <br />�% r <br />Site Address: 216 <br />`I ; °, z <br />�e <br />City, State, Zip Code: `���, c° <br />Sr • z <br />Area Code - Telephone <br />Number: ,. C 2 <br />. 3 — <br />INDUSTRIAL: <br />CONTRACTOR <br />R/W <br />Name: a c 6-0 I TV t ,E l <br />Address: ez Lq <br />I <br />U t vvo6' ' <br />Ft, X WIDTH: Ft, <br />City, tate, Zip Code: OLV"' a cn� r <br />q 5111 <br />Area Code - Telephone <br />Number: <br />�,lo R — '�" <br />` <br />Date; <br />Received By; <br />The undersigned hereby applies for permission to excavate, construct and/or othervise encroach on County Highway Right -of -Way on the <br />side of _ approximately feet/mile <br />of _ by installing <br />commence on or about for approximately days. <br />SKETCH (Separate sheet may be submitted) <br />Will this project be self -installed? YES NO <br />P:IENCP,OACHIdEIdTSIAlasler FormsdemplaleslENCRDAGHMEI� PERMIT DRIVEWAY.doc �0(II00) <br />Work will <br />Contractor's License 2 <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE; <br />APN <br />FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />AREA: <br />QUAD <br />TYPE: <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: Ft, <br />The undersigned hereby applies for permission to excavate, construct and/or othervise encroach on County Highway Right -of -Way on the <br />side of _ approximately feet/mile <br />of _ by installing <br />commence on or about for approximately days. <br />SKETCH (Separate sheet may be submitted) <br />Will this project be self -installed? YES NO <br />P:IENCP,OACHIdEIdTSIAlasler FormsdemplaleslENCRDAGHMEI� PERMIT DRIVEWAY.doc �0(II00) <br />Work will <br />Contractor's License 2 <br />