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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />fTa►�l wl'Jk\ Ems_\ � IRA W_\9 q RM y:Z-ML IF Mjgj�tbj <br />PERMIT APPLICATION <br />PS-22n2A4A -Rh <br />Date: lg 10 l2? <br />Received By: <br />CR#: 0 7 c 4 a13 <br />APPLICANT <br />Name: <br />' <br />,✓ <br />PA4 c� <br />Address: (o <br />APIN IfL A <br />City, State, Zip Code:rD <br />v CA I � <br />Area Code - Tele hone <br />Number: ? <br />Email: p <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />u Lower 36nos <br />Site Address: j4PQDW <br />AREA: flin0e0ran <br />City, State, Zip Code: <br />S �� <br />Area Code - Tele hone <br />Number: <br />FORMS: <br />CONTRACTOR <br />Name: <br />NOTES: <br />Address: <br />L/ <br />Ci , State, Zi Code: <br />Area Code - Telephone <br />TYPE: <br />Number: <br />QUANTITY <br />Date: lg 10 l2? <br />Received By: <br />CR#: 0 7 c 4 a13 <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the <br />Nghc5* z side of approximately 3 feeN�l jt �� <br />of Wki 5 k oey 55 , by installing <br />commence on or about <br />may <br />for approximately <br />Will this project beself-installed? YES �NO <br />x�xcaoncxrnExrsum:x, r�,rer•.o��xcaoacx n�irt rExwn cnrvnvnv aoo �wroer <br />Contractor's License � � �� 7l� <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB M <br />11005 ISSUE DATE: <br />APIN IfL A <br />5 0- p 1 FEE DUE: <br />EXP, DATE: <br />DRIVEWAYS: <br />STREET: L3oto <br />u Lower 36nos <br />1A <br />AREA: flin0e0ran <br />QUAD <br />TYPE: <br />FORMS: <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />I @FRONTAGE <br />COMMERCIAL: <br />NDUSTRIAL:@ <br />RIW <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: <br />Ft. <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the <br />Nghc5* z side of approximately 3 feeN�l jt �� <br />of Wki 5 k oey 55 , by installing <br />commence on or about <br />may <br />for approximately <br />Will this project beself-installed? YES �NO <br />x�xcaoncxrnExrsum:x, r�,rer•.o��xcaoacx n�irt rExwn cnrvnvnv aoo �wroer <br />Contractor's License � � �� 7l� <br />days. <br />Work will <br />