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COUNTY' OF SAN JOAQUIN <br />DEPARTMENT OF PUL.IC WORKS <br />L�KIVCWAYZ) AND PAVEIJ i"KU)N I AGES <br />PERMIT APPLICATION <br />Received By: '�' bv <br />lot <br />APPLICANT <br />JOB #. <br />Name, <br />F - C V LI I M <br />EXP, DATE: <br />Addres . /Ll <br />LN 51 ,, L I F <br />Avg <br />City, State, Zip <br />Code: k gc/q(()AI Ur l I' <br />qy3 <br />Area Code - <br />Telephone Number:"., � <br />2 <br />NOTES: <br />SITE INFORMATION: <br />yv <br />If <br />Parcel Owner's Name: <br />V . e' c,y--ttt(/ <br />1. <br />Site Address: <br />0 a "� "t zk E <br />' `�" <br />City, State, Zip <br />Code: 2CA110A) CA, cLE14-0' <br />Area Code - Telephone Number: okC;X( <br />P, R/W <br />gz)C <br />CONTRACTOR <br />Name: <br />PAVED FRONTAGE <br />LENGTH: <br />Address: <br />City, State, Zip <br />Code: <br />Area Code - Telephone Number: <br />Received By: '�' bv <br />lot <br />The undersigned hereby applies for permission to excavate, construct ar�d/or otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feeunue <br />of by installing <br />commence on or about <br />for approximately <br />days. <br />Work will <br />SKETCH (Separate sheet may be submitted) <br />1, <br />; <br />4rr- <br />1 <br />Will this project be self -in stalled? <br />YES NO Contractor's License <br />P:IEIJCROACHMENTSrAiasler EcrmsTenplaleslEPICR04CHLdENT PERhAIT CRI'JEVdAY.dx (UWOP� <br />OFFICE USE ONLY <br />JOB #. <br />11005 ISSUE DATE: <br />APN 120-C<, FEE DUE: <br />EXP, DATE: <br />DRIVEWAYS: <br />STREET: VINE <br />Avg <br />AREA: <br />QUAD <br />TYPE <br />Atl`1P'4u%tJz44 <br />FORMS: Mzl�wwi <br />„i <br />0167 <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />F@ RONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />P, R/W <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: Ft. <br />The undersigned hereby applies for permission to excavate, construct ar�d/or otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feeunue <br />of by installing <br />commence on or about <br />for approximately <br />days. <br />Work will <br />SKETCH (Separate sheet may be submitted) <br />1, <br />; <br />4rr- <br />1 <br />Will this project be self -in stalled? <br />YES NO Contractor's License <br />P:IEIJCROACHMENTSrAiasler EcrmsTenplaleslEPICR04CHLdENT PERhAIT CRI'JEVdAY.dx (UWOP� <br />