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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWp,I'S AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />Received By: 5-c— <br />CR#, "�✓ i l �' J <br />APPLICANT <br />JOB #: <br />F '/ <br />Name: At <br />�>O 1 <br />Z2Ca t00 -0b FEE DUE: <br />Address; Z <br />3 11� 7 <br />STREET: <br />_ZZ <br />City, State, Zi Code: <br />U <br />Area Code - Telephone <br />Number: ' <br />eJ . <br />SITE INFORMATION; <br />NOTES: <br />Parcel Owner's Name; <br />DRIVEWAY <br />Site Address: ;.7e2 <br />Z' - <br />QUANTITY <br />Cit , State, Zip Code:, <br />City, <br />AGRICULTURE; <br />- <br />Area Code - Tele hone <br />Number: .— <br />= 2r <br />INDUSTRIAL <br />CONTRACTOR <br />Name: <br />RESIDENCE: <br />Address: <br />PAVED FRONTAGE <br />City, State, Zip Code; <br />Ft. X WIDTH; Ft, <br />Area Code <br />- Telephone <br />Number: <br />Received By: 5-c— <br />CR#, "�✓ i l �' J <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County H��hway Ri hg t-of-Wa <br />�j M side of SAN �r�C approximately fy 2c� Cf/rr�il C�4g r <br />Of "AWia by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />Will this project beself-installed? _ _l'ES NO Contractor's License <br />P:IENCROACHMENTSIMnsler Forms-TemplalaslENCROACHMENI' PERMIT DRIVEWAY.doc (OBbB) <br />days. <br />yon the <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN <br />Z2Ca t00 -0b FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />SE>At4 Adr=, <br />AREA: <br />MAuj gra QUAD r5W <br />TYPE: <br />/�Z/✓6��r9Y f1FP�2ch <br />FORMS: <br />1'y <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 andlor otherwise encroach on County H��hway Ri hg t-of-Wa <br />�j M side of SAN �r�C approximately fy 2c� Cf/rr�il C�4g r <br />Of "AWia by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />Will this project beself-installed? _ _l'ES NO Contractor's License <br />P:IENCROACHMENTSIMnsler Forms-TemplalaslENCROACHMENI' PERMIT DRIVEWAY.doc (OBbB) <br />days. <br />yon the <br />Work will <br />