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� (C- c/i �0u D 6 ¢a <br />COUNTY OF SAN JOAQUIN � Dale: <br />DEPARTMENT OF PUL.IC WORKS <br />Received By: <br />DRIVEWAYS AND PAVED Ff�CIN I�AOES <br />- PERMBT APPLfCAiIC1N CR#: <br />APPLICAIVT <br />OFFICE USE ONLY <br />Name: � t7 � � <br />11005 ISSUE DATE: <br />A ress: /�v �, I1� c�,:,j' <br />�� ;•s <br />Cit ,State, Zi Code: 'lrr✓ <br />,,= C �� . (� <br />Area Code -Tele hone Number: <br />,���� — ' � �;� <br />SITE INFORMATION: <br />Parcel Owner's Name: ,�'? ��� ;' ,fig: <br />��r-,,<,J <br />Site Address; (g3 5. ww6•.►E2, <br />12, , <br />Cit ,State, Zi Code: � .,�j'�r � <br />�' S 3 <br />Area Code -Tele honeNumber.,�c�' <br />,lJs-�'.- fi �� <br />CONTRACTOR <br />TYPE: <br />Name: fl — � a' - -�J <br />WIDTHS <br />Address: � tJZI - �/1 <br />Cit ,State, i Code: �?c},� � 1.rc�- <br />�%.. < G` :;„ <br />Area Code -Tele hone Number:;t�.'f � <br />F ''—,�) S <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 5rJ . r.c.» �h.�s�' approximately - i C1 (fe`e_D'mile <br />of /� i i'�rz-� ��1� , by installing 7 � �' � � �� <br />Work will <br />commence on or about for approximately days. <br />SKETCH (Separate sheet may be submitted) I✓h.y � 5� �, f� � ��,�� <br />.�. <br />�`�' l �� r � � �� <br />I,i� � r .jt�c. r ,�' <br />�-.r�v� <br />sra . ��,���� ,�� . <br />��f�rL - <br />Wilf this project be self -installed? YES NO Contractor's License _�1'����1 � �rs"f�7ca%,i'� •1 1 �/� <br />3c ��� �� � <br />' <br />P:IEIJCRDACHMENTSMasler Porms-TemplaleslL=WCRCACHAIENT PERA7IT DRIVEW4'LAoc (08100) <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN 2 <br />¢S � (�} � FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />AREA: <br />QUP,D <br />TYPE: <br />FORMS: <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />RIW <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: 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 5rJ . r.c.» �h.�s�' approximately - i C1 (fe`e_D'mile <br />of /� i i'�rz-� ��1� , by installing 7 � �' � � �� <br />Work will <br />commence on or about for approximately days. <br />SKETCH (Separate sheet may be submitted) I✓h.y � 5� �, f� � ��,�� <br />.�. <br />�`�' l �� r � � �� <br />I,i� � r .jt�c. r ,�' <br />�-.r�v� <br />sra . ��,���� ,�� . <br />��f�rL - <br />Wilf this project be self -installed? YES NO Contractor's License _�1'����1 � �rs"f�7ca%,i'� •1 1 �/� <br />3c ��� �� � <br />' <br />P:IEIJCRDACHMENTSMasler Porms-TemplaleslL=WCRCACHAIENT PERA7IT DRIVEW4'LAoc (08100) <br />