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COUNTY COUNTY OF SAN JOAQUIN DEPARTMENT OF PULIC WORKS DRIVEWAYS AND PAVED FRONTAGES PERMIT APPLICATION APPLICANT OFFICE USE ONLY JOB #: APN EXP, DATE: STREET: r,20 AREA:QUAD Name: R o a Address: L. City, Stale, Zip Code: 12 4 j. Jp mw Area Code -Tele hone Number: '7 6t Email: r v rr+ a oa • F SITE INFORMATION: Parcel Owner's Name: t M u. 6a Site Address F a S c City, State, Zip Code: Ca Area Code - Telephone Number: CONTRACTOR Name: Address: City, Slate, Zip Code: Area Code - Telephone Number: RESIDENCE: -z3 G) z4 7 - Date: V 111133 Recelved By: %* CR#: olkr?L8 The undersigned hereby applies for ppermission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the side of %.)t l IL } i A v& approximately VS nke(f efhniis of G 5k , by installing Work will commence on or about for approximately days. SKETCH (Separate sheet may be submitted) c. JAe d Will this project be self -installed? `It YES NO XV:IICAOAGIMFM3V.b,W famelu,pibslElkflOACHN&RPEAA9fOM'flYATJw)41g8) Contractor's License OFFICE USE ONLY JOB #: APN EXP, DATE: STREET: r,20 AREA:QUAD 11005 ISSUE DATE: FEE DUE: DRIVEWAYS: S Willc1�: A%/ze TYPE: t W FORMS: ss i>w—/ NOTES: gn (2.n ` DRIVEWAY TYPE: QUANTITY WIDTHS AGRICULTURE: I @FRONTAGE COMMERCIAL: INDUSTRIAL: QRM RESIDENCE: PAVED FRONTAGE LENGTH: FL X WIDTH: FI. The undersigned hereby applies for ppermission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the side of %.)t l IL } i A v& approximately VS nke(f efhniis of G 5k , by installing Work will commence on or about for approximately days. SKETCH (Separate sheet may be submitted) c. JAe d Will this project be self -installed? `It YES NO XV:IICAOAGIMFM3V.b,W famelu,pibslElkflOACHN&RPEAA9fOM'flYATJw)41g8) Contractor's License