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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />OFFICE <br />USE ONLY <br />Name: <br />JOB #; <br />lleA kk u <br />Address: d o 3 <br />Cll Stale <br />EXP, DATE: <br />woo <br />Z Code: d � <br />i <br />c G <br />9 _ <br />Area Code - Telephone <br />TYPE: Dw <br />Number:a <br />O - 1 <br />EmaIL <br />NOTES: <br />1. <br />e.A to %•Cowl <br />SITE INFORMATION: <br />Parcel <br />Owner's <br />Name; <br />Site Address: 0 f ni-e4 0 <br />Clty,State, I Code; o Q' c <br />Area Code <br />• Telephone <br />Number; <br />479 - Icy <br />CONTRACTOR <br />Name; <br />COMMERCIAL: <br />Address; <br />CIty, State <br />Zip Code; <br />Area Code <br />-Tele hone Numbe <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County H�hway Right-of•Way on the <br />Neri-l% side of7.wrntr` approximately i lT.A a mile rdAmsr <br />of n AVr< RA I by Installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />WIII this project be soli -Installed? <br />,YES NO <br />M.Y:AVXIIMI:IIMI:NNIUImIm I�anw�talYllntnNiAYXNMNIINY'.Nf I'I IINIf IXIWN.WAYiNmpMIAIA) <br />days, <br />Contractor's License <br />rhR•T1757111 <br />OFFICE <br />USE ONLY <br />JOB #; <br />11005 ISSUE DATE; <br />APN o15-060-nA <br />FEE DUE: <br />EXP, DATE: <br />DRIVEWAYS: <br />STREET 1051 <br />WTiAr�AeILI <br />AREA: t_ NJ <br />QUAD " <br />TYPE: Dw <br />N coakrML <br />FORMS: sS ��.J <br />wFQ-t"1 <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />I A RAN <br />RESIDENCE: <br />� <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, <br />X WIDTH: <br />Ft. <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County H�hway Right-of•Way on the <br />Neri-l% side of7.wrntr` approximately i lT.A a mile rdAmsr <br />of n AVr< RA I by Installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />WIII this project be soli -Installed? <br />,YES NO <br />M.Y:AVXIIMI:IIMI:NNIUImIm I�anw�talYllntnNiAYXNMNIINY'.Nf I'I IINIf IXIWN.WAYiNmpMIAIA) <br />days, <br />Contractor's License <br />rhR•T1757111 <br />