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COUNTY OF SAN JOAQUIN DEPARTMENT OF PULIC WORKS DRIVEWAYS AND PAVED FRONTAGES PERMIT APPLICATION PS _�.xnnu� u Date: LA141?'� Received By: i APPLICANT Name: �iis u� (kvr S w Address: FEE DUE: City, State, Zip Code: k N7—h z Area Code - Telephone Number: yjn 26 r - M q. 9 Email: cati SITE INFORMATION:' Parcel Owner's Name: FORMS: Site Address: L S City, State, Zip Code: bA - M x "' L -- Area Code - Telephone Number: TYPE: QUANTITY CONTRACTOR WIDTHS Name: @FRONTAGE Address: COMMERCIAL: City, State, Zip Code: INDUSTRIAL: Area Code -Telephone Number: R/W Date: LA141?'� Received By: i The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the S-oA* side of approximately Chet feet/mile of �, by installing sheet maybe submitted) for approximately �J Will chis project be self-irisialled? V YES NO XIENOROAOHMEMSIMasle,Fameiemplates�ENCROgCXMEM PERMIt DRIVEWAY doo IOBA18) Contractors License days. ' Work will OFFICE USE ONLY JOB #: 11005 ISSUE DATE: APN FEE DUE: EXP. DATE: DRIVEWAYS: STREET: M.90 N Lo we ✓ Sa r:rl nm on4D AREA: Lp i QUAD int TYPE: FORMS: NOTES: DRIVEWAY TYPE: QUANTITY WIDTHS AGRICULTURE: @FRONTAGE COMMERCIAL: INDUSTRIAL: @ R/W RESIDENCE: PAVED FRONTAGE LENGTH: Ft, X WIDTH: Ft. The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the S-oA* side of approximately Chet feet/mile of �, by installing sheet maybe submitted) for approximately �J Will chis project be self-irisialled? V YES NO XIENOROAOHMEMSIMasle,Fameiemplates�ENCROgCXMEM PERMIt DRIVEWAY doo IOBA18) Contractors License days. ' Work will