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`e�N <br />COUNTY OF SAN JOAQUIN Date: <br />DEPARTMENT OF PULIC WORKS <br />DRIVIEVVAYS ANG PAVED f-RONTAUtb <br />PERMIT APPLICATION <br />APPLICANT <br />Name: r t e l& C c t� <br />Address: (? o . Gsv <br />City, State, Zip <br />Code: rti, cjeAk <br />Area Code Telephone Number: QwAlF S'�S�7fw <br />SITE INFORMATION: <br />Parcel Owner's Name: VqZPt jue a✓ <br />Site Address: 11 b E / S c«U <br />c <br />QUAD <br />City, State, Zip Code: w cry CG(a `? <br />Area Code Telephone Number: <br />CONTRACTOR <br />Name: <br />Address: <br />City, State, Zip Code: pvLawkct c lcx- <br />Area Code <br />- Telephone <br />TYPE: <br />QUANTITY <br />Number: <br />AGRICULTURE: <br />&? S ? <br />Received by: <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feeumile <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 -installed? YES NO Contractor's License <br />P:IENCRCACHMENTSUfasler Foims-TemplafeslENCRCACHMENT PEREIIT DRIVEWAY.doc (00108} <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN S`� i 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 />RNV <br />RESIDENCE: <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 Highway Right -of -Way on the <br />side of approximately feeumile <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 -installed? YES NO Contractor's License <br />P:IENCRCACHMENTSUfasler Foims-TemplafeslENCRCACHMENT PEREIIT DRIVEWAY.doc (00108} <br />days. <br />Work will <br />