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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYN) AND PAVED FRUN'I AULO <br />PERMIT APPLICATION <br />APPLICANT <br />Name: <br />e ^ <br />Address: (tr / lworA SAxw# &% <br />City, State, Zip Code: CA 0C 9 (;.q to <br />Area Code Telephone Number: Oq <br />EXP. DATE: <br />SITE INFORMATION: <br />Parcel Owner's Name: .2mve e, S <br />Site Address: 43 3 <br />City, State, Zip Code: & ,d <br />Area Code - Telephone Number: <br />CONTRACTOR <br />Name: v <br />Addrec w L4 <br />City, State, Zip Code: a c tr ror-.q,j Zd <br />Area Code <br />- Tele <br />hone <br />Number: <br />QUANTITY <br />46fl <br />AGRICULTURE: <br />Uate: <br />Received By: <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County H' ay Rig�it-of-Way on the <br />E Awe side of �Vwtzz. St. approximately 2 fe He IL, �r: <br />of C.1 -IE" WA19 1QD by installing <br />commence on or about <br />for approximately <br />days. <br />Work will <br />SKETCH (Separate sheet may be submitted) <br />I <br />'V <br />Will this project be self -installed? YES NO Contractor's License <br />P:IENCROACHMEPITSV,lasler FomsdemplaleslENCROACHMENTPERMIT CRIVEWAY.doc (08108) <br />OFFICE USE ONLY <br />JOB M <br />11005 ISSUE DATE: <br />APN pg <br />7 t 3 fj 412 FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: Ho&1d( FJ <br />AREA: 5tar.,Jc46„ <br />. <br />QUAD <br />TYPE: �,r <br />FORMS: <br />wvl/ <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />@ RIW <br />RESIDENCE: <br />o� <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 H' ay Rig�it-of-Way on the <br />E Awe side of �Vwtzz. St. approximately 2 fe He IL, �r: <br />of C.1 -IE" WA19 1QD by installing <br />commence on or about <br />for approximately <br />days. <br />Work will <br />SKETCH (Separate sheet may be submitted) <br />I <br />'V <br />Will this project be self -installed? YES NO Contractor's License <br />P:IENCROACHMEPITSV,lasler FomsdemplaleslENCROACHMENTPERMIT CRIVEWAY.doc (08108) <br />