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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />Date: .(A) IR 1?, 2, <br />Received By: <br />CR #: 0 % ht 7 <br />APPLICANT <br />Name: <br />rZT(Ai <br />Address: <br />41 <br />Cit , State, Zip Code: <br />ra <br />EXP. DATE: <br />Area Code -Tell <br />h ne Number:. L QA O <br />Email: <br />2cm s (tx e u <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />Site Address: l <br />Lc9 F <br />City, State, Zi Code: <br />roc VLT c A j <br />Area Code - Telephone <br />Number: <br />CONTRACTOR <br />Name: <br />NOTES: <br />Address: d <br />DRIVEWAY <br />City, State, Zip Code: <br />0 <br />Area Code -Telephone Number: ,,w EP -209/409 <br />Date: .(A) IR 1?, 2, <br />Received By: <br />CR #: 0 % ht 7 <br />The undersigned hereby applies for permission io excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feet/mile <br />of by installing <br />commence on or about <br />may <br />Will this project be self -installed? YES NO <br />%�ENLROpCHMEMA1Master Fwma-TemplateslENCR0ACH67ENi PER1Ali URNEWAYda1AANA) <br />far approximately <br />Contractor's License <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN <br />FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET:. iA� NCLe <br />A..v <br />AREA: <br />QUAD <br />TYPE: <br />At <br />FORMS: R -t7 <br />s) <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />@ <br />RM <br />RESIDENCE: <br />x 7 <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: <br />Ft. <br />The undersigned hereby applies for permission io excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feet/mile <br />of by installing <br />commence on or about <br />may <br />Will this project be self -installed? YES NO <br />%�ENLROpCHMEMA1Master Fwma-TemplateslENCR0ACH67ENi PER1Ali URNEWAYda1AANA) <br />far approximately <br />Contractor's License <br />days. <br />Work will <br />