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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />CII(IVEWAI Z) ANU PAVED FKUN I AfotO <br />PERMIT APPLICATION <br />Date: <br />Received By: <br />APPLICANT <br />Name:(7W*4VI <br />11005 ISSUE DATE: <br />Address: S <br />r., t <br />City, State, Zip Code: <br />ce O $ al <br />STREET: <br />Area Code - Telephone <br />Number;, — r <br />SITE <br />INFORMATION: <br />Parcel Owner's Name: <br />(� <br />Site Address:' " I $. ,r_ <br />City, State, Zip Code: Slycmno, <br />CAQ clsajS7 <br />Area Code - Telephone <br />Number: Zoq 20 <br />QUANTITY <br />CONTRACTOR <br />Name: <br />Address: <br />COMMERCIAL: <br />City, State, Zip Code: <br />INDUSTRIAL: <br />Area Code - Telephone <br />@ R/W <br />Number: <br />Date: <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 feM in e <br />of by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />'l Will this project beself-installed? YES NO <br />P:IENCRDACHMEWTSUAasler forms-7emplaleslENCRDACNMENT PERAl1T DRNEVlAY.dac (88188) <br />Contractor's License <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APNs <br />/4R7 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 />@ R/W <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: <br />Fth <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 feM in e <br />of by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />'l Will this project beself-installed? YES NO <br />P:IENCRDACHMEWTSUAasler forms-7emplaleslENCRDACNMENT PERAl1T DRNEVlAY.dac (88188) <br />Contractor's License <br />days. <br />Work will <br />