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COUNTY OF SAN JOAQUIN DEPARTMENT OF PULIC WORKS DRIVEWAYS AND PAVED FRONTAGES PERMIT APPLICATION Date: io12/0_ Received By: v_ CR #: A -1.7 0 41 APPLICANT Name: ct e < o Address: Cit State, Zi Code: reA C 41 , Area Code -Tell hone Number: f 1 o 6 � r 4 Email: = yce^^ P SITE INFORMATION: Parcel Owner's Name: Site Address: C� b0 tFA TYPE: r1 LJ Ci State, Zi Code: c0 L , Area Code -Tele hone Number: S I o ( y C CONTRACTOR Name: DRIVEWAY Address: TYPE: City, State, Zi Code: QUANTITY Area Code - Tele hone Number: Date: io12/0_ Received By: v_ CR #: A -1.7 0 41 The undersigned hereby applies for permiss11on to excavate, construct and/or otherwise encroach on County Highwai sRigh-of-Way on the a } side of P n 12 Rd approximately .6 Cfee}1m of � ` e A — tL Sl by installing Work will commence on or about for approximately days. %�ENCROACNMENiSWaAa FanrsiertpklealENCROACHMEIRPERAUI RRNEWAYEoo(OBNB� OFFICE USE ONLY SOB #: 11005 ISSUE DATE: APN 50•r50-2$ FEE DUE: EXP, DATE: DRIVEWAYS: STREET: 410.0C Gals Rel AREA: Yract` QUAD TYPE: r1 LJ , nre c l x FORMS: st6/ R 17 NOTES: DRIVEWAY TYPE: QUANTITY WIDTHS AGRICULTURE: FRONTAGE COMMERCIAL: INDUSTRIAL: RIW RESIDENCE: PAVED FRONTAGE LENGTH: Ft, X WIDTH: Ft. The undersigned hereby applies for permiss11on to excavate, construct and/or otherwise encroach on County Highwai sRigh-of-Way on the a } side of P n 12 Rd approximately .6 Cfee}1m of � ` e A — tL Sl by installing Work will commence on or about for approximately days. %�ENCROACNMENiSWaAa FanrsiertpklealENCROACHMEIRPERAUI RRNEWAYEoo(OBNB�