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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />(1NIVFWAVi ANI: 1'AVIED FRONTAGES <br />PERMIT APPLICATION <br />Date: <br />Receiuecl By:. <br />APPLICANT <br />Name: M K& <br />11005 ISSUE DATE: <br />Address: 0(11 i <br />ue% �. <br />.Lit Stale, Zip Code: <br />UC, '] <br />Area Code - Tele hone <br />Numbe —`4 <br />SITE INFORMATION: <br />Parcel Owner's Name: tnivae, <br />.fit <br />Site Address: ( t <br />..TA W <br />City, Stats:, Zip Code: fkp&A <br />NOTES: <br />Area Code -Telephone <br />umbe cy - GY 7 <br />CONTRACTOR <br />Name: <br />QUANTITY <br />Address: <br />AGRICULTURE: <br />City, State, Zip Code: <br />@FRONTAGE <br />Area Code -Telephone <br />Number: <br />INDUSTRIAL <br />Date: <br />Receiuecl By:. <br />The undersigned hereby applies for permission to excavate; construct and/or otherwise encroach on County Highway Rig�ht�of-Way on the <br />N/E5r side of_;elinxgvc:t1 Aim approximately 4 o4714ff <br />of by installingrul � <br />commence on or abouf <br />(Separate sheet may be submiffed) <br />i� 'JVill Phis project be self-insfalled? ._YES — NO <br />P.Lt:eHOACfU.1817 s11L3ge, Faros•'errpfslci�EIICROACHLCIC(PFkI/f(CHIVE'h'Al'.Joc�f2,4G� <br />for approximately <br />Contracfgr's Licenss . <br />days, <br />will <br />OFFICE USE ONLY <br />JOS #: <br />11005 ISSUE DATE: <br />APN <br />_ <br />zfy. 3�o- 31 FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />f�Aamoyzw AV60 <br />AREA: <br />91po" QUAD x <br />TYPE: <br />;pw A60,4 Ae44 <br />FORMS:Wr/ <br />>� <br />NOTES: <br />DRIVEWAY <br />YP <br />TE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL• <br />INDUSTRIAL <br />@ R/W <br />RESIDENCE: <br />/k( <br />PAVED FRONTAGE <br />LENGTH: <br />_ <br />Ft, X WIDTH: Ftq <br />The undersigned hereby applies for permission to excavate; construct and/or otherwise encroach on County Highway Rig�ht�of-Way on the <br />N/E5r side of_;elinxgvc:t1 Aim approximately 4 o4714ff <br />of by installingrul � <br />commence on or abouf <br />(Separate sheet may be submiffed) <br />i� 'JVill Phis project be self-insfalled? ._YES — NO <br />P.Lt:eHOACfU.1817 s11L3ge, Faros•'errpfslci�EIICROACHLCIC(PFkI/f(CHIVE'h'Al'.Joc�f2,4G� <br />for approximately <br />Contracfgr's Licenss . <br />days, <br />will <br />