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Lf <br />Mw <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVLVV 1 S AN1J PAVt1J FfIU1'ITAGES <br />PEIRMIT APPLICATION <br />Received By: <br />APPLICANT <br />Name: <br />t_i' <br />Address: <br />EXP. DATE: <br />DRIVEWAYS: <br />City, State, Zip Code: <br />?TZ64"AN ZW. <br />Area Code Tele hone <br />Number: _ • <br />1 - Q <br />SITE INFORMATION: <br />Parcel Owner's Name:rw, <br />c C 1!1Site <br />Address: <br />City, State, Zip Code: <br />,' <br />Area Code <br />Number: ` j— <br />.Telephone <br />CONTRACTOR <br />Name: <br />Address: <br />COMMERCIAL: <br />City, State, Zip Code: <br />Area Code - Telephone <br />Number: <br />Received By: <br />T,•h��' undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Hi way Right -of -Way on the <br />Nam'+' side ofrtc1&�OgAl 4 Z. approximately /SGi' e He &rf57' <br />of 7T20G)o* xD4 , ZODI , by installing <br />commence on or about <br />SKETCH (Separate sheet maybe submitted) <br />for approximately <br />Will this project be self -installed? YES NO Contractor's License <br />P:IENCROACHSIENTSUdasler Fortns-TemplaleslENCROACHMENTPERMIT DRIVEIVAY.doc (08'08) <br />Work will <br />days. <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN <br />g0930—ZO FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />?TZ64"AN ZW. <br />_ <br />AREA: <br />G,pp/ QUAD Aa <br />TYPE: <br />20 <br />FORMS:,e- <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: Fte <br />T,•h��' undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Hi way Right -of -Way on the <br />Nam'+' side ofrtc1&�OgAl 4 Z. approximately /SGi' e He &rf57' <br />of 7T20G)o* xD4 , ZODI , by installing <br />commence on or about <br />SKETCH (Separate sheet maybe submitted) <br />for approximately <br />Will this project be self -installed? YES NO Contractor's License <br />P:IENCROACHSIENTSUdasler Fortns-TemplaleslENCROACHMENTPERMIT DRIVEIVAY.doc (08'08) <br />Work will <br />days. <br />