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f3 Zpba'1g0 <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Name: EVA <br />JOB #: <br />APN ZIZ-d?D- <br />EXP, DATE: <br />STREET: 499 <br />AREA: !!r~ <br />TYPE: <br />FORMS: <br />Address: 12VI I W <br />• f- 1 <br />City, State, Zip Code: `j <br />Area Code - Tele hone Number: <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />Site Address: <br />City, State, Zip Code: <br />Area Code Telephone Number: <br />CONTRACTOR <br />Name: lac <br />Address: <br />City, State, Zip Code: <br />Area Code - Telephone Number: <br />Date; f tq 40 <br />Received By; <br />0 <br />CR#: 1 4�i352 <br />The �dersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Hi way Right -of -Way on the <br />side of y � approximately a He &Vi sr <br />of eaVdW1, A4444W AP , , by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />Will this project beself-installed? YES NO <br />P:IENCRCACHMENTSIMaster Forms-TamplalaslENCRCACHMENi PERMIT ORNEWAY.doo (OSPoS) <br />for approximately <br />Contractor's License <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />APN ZIZ-d?D- <br />EXP, DATE: <br />STREET: 499 <br />AREA: !!r~ <br />TYPE: <br />FORMS: <br />11005 ISSUE DATE: <br />FEE DUE: <br />DRIVEWAYS: <br />ANY Lia <br />QUAD a5W <br />A/10A1vCX <br />N OTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />R/W <br />Rll <br />ESIDENCE: <br />*? <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: Ft. <br />The �dersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Hi way Right -of -Way on the <br />side of y � approximately a He &Vi sr <br />of eaVdW1, A4444W AP , , by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />Will this project beself-installed? YES NO <br />P:IENCRCACHMENTSIMaster Forms-TamplalaslENCRCACHMENi PERMIT ORNEWAY.doo (OSPoS) <br />for approximately <br />Contractor's License <br />days. <br />Work will <br />