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PO <br />x <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />f RIVEWAYS APJU PAVEU FRGJNI"AGES <br />PERMITAPPLICATION <br />Dafe: <br />Received By: <br />Cf <br />APPLICANT <br />JOB M <br />Name: Glet)r' <br />APN QR6640.3a <br />FEE DUE: <br />Address: 3 <br />DRIVEWAYS: <br />/ ` <br />Q -G✓ <br />City, State, Zip Code: <br />dGj( <br />q <br />Area Code - Telephone <br />Number; (Acal Qt <br />SITE INFORMATION: <br />Parcel Owner's Name; <br />-� &rV <br />ly <br />Site Address: S <br />WIDTHS <br />AGRICULTURE: <br />City, State, Zip Code: <br />FSG <br />COMMERCIAL: <br />Area Code Telephone <br />Number: <br />@ RNV <br />RESIDENCE: <br />CONTRACTOR <br />Name: (L <br />LENGTH: <br />Ft. X WIDTH: Ft. <br />Address: <br />City, State Zip Code: <br />Area Code "Telephone <br />Number: <br />Dafe: <br />Received By: <br />Cf <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feet/mile <br />of , by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />Will this project kle self -installed? YES _ NO Contractor's License <br />P:IENCRCACHAIENTSIMasler Fortns-iemplaleslENCROACHMENT PERMIT DRIVEWAY.doc (OBIOd) <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB M <br />11005 ISSUE DATE: <br />APN QR6640.3a <br />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: Ft. <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feet/mile <br />of , by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />Will this project kle self -installed? YES _ NO Contractor's License <br />P:IENCRCACHAIENTSIMasler Fortns-iemplaleslENCROACHMENT PERMIT DRIVEWAY.doc (OBIOd) <br />days. <br />Work will <br />