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Y <br />(� <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVE[) FRON1fA�ES <br />PEI�M('G APPLICA'iION <br />A LICA T <br />Name: <br />' c�, � � � <br />Address: ,� ss 5 , e yr�q rJ <br />Cit ,State, Zi Code: ('ccC CA 5 3 �b N <br />Area Code -Tele hone Number: Zo5 - 4D'i - 7 I <br />SITE INFORMATION: <br />Parcel Owner's Name: � <br />,,�� S� N u. ins e-tt'i <br />Site Address: 8,5 S s . e, M ct N <br />Cit ,State, Zi Code: /`aC f� q 5 0 '� <br />Area Code -Tele hone Number: �, C� - I b — � 7 � Z <br />CONTRACTOR <br />Name: <br />Address: <br />Cit ,State, Zi Code: <br />Area Code <br />-Tele <br />DRIVEWAY <br />hone <br />Number: <br />QUANTITY <br />Dafie: <br />Received By: %� _ <br />CR#: <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Hi � ay Right -of -Way on the <br />,Cf.��' side of �.Y'rs/iliV +�v, approximately 7� fenile �� <br />of �.'ri✓rt� .2'r i�,l.Ac�/ , by installing <br />commence on or about <br />for approximately <br />SKETCH (Separate sheet may be submitted) <br />1 <br />N <br />.� <br />� � ,J <br />Will this project be self -installed? YES NU <br />P:IENGROACHMENTSVdasler Famis-TemplateslEIVCROACHMENT PERMIT ORIVEWAY.dac (08108) <br />Contractor's License <br />days. <br />Worl< will <br />t' �"'Z.i�:�o'�7 i <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN 2s3-3� <br />-moo FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: ��/yy�fq�,/ <br />�D, <br />AREA: �;.q�y <br />QUAD ry-!,J <br />TYPE: ,—�y�! <br />f1�ltogca.l <br />FORMS: <br />� /? <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />RIW <br />RESIDENCE: <br />� <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: <br />Ft. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Hi � ay Right -of -Way on the <br />,Cf.��' side of �.Y'rs/iliV +�v, approximately 7� fenile �� <br />of �.'ri✓rt� .2'r i�,l.Ac�/ , by installing <br />commence on or about <br />for approximately <br />SKETCH (Separate sheet may be submitted) <br />1 <br />N <br />.� <br />� � ,J <br />Will this project be self -installed? YES NU <br />P:IENGROACHMENTSVdasler Famis-TemplateslEIVCROACHMENT PERMIT ORIVEWAY.dac (08108) <br />Contractor's License <br />days. <br />Worl< will <br />t' �"'Z.i�:�o'�7 i <br />