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A <br />P)S — IclD3yief 0 <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />Date: � 1 'ir s <br />Received By: <br />A P (CANT <br />Name: <br />1,6 <br />1r, <br />Address: <br />DRIVEWAYS: <br />City, State, Zip C6cle: <br />3 hrwc&vN 9 <br />Area Code - Telephone <br />Number: / 6e 31 <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />✓ ir+ <br />Site Address: .0 <br />L906 I/Lf Ale <br />City, State, Zip Code: <br />DRIVEWAY <br />Area Code - Telephone <br />Number: D Z 17 o;3 k <br />QUANTITY <br />CONTRACTOR <br />Name: <br />Address: <br />COMMERCIAL• <br />City, State, Zip Code: <br />INDUSTRIAL: <br />Area Code - Telephone <br />Number: <br />RESIDENCE: <br />Date: � 1 'ir s <br />Received By: <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feetlmile <br />Of by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />INill this project be self -installed? ��"�I YES NO <br />P:IENCROACHMEIJTSIMasler Fortnr.-TempialeslENCROACHh1EM PERMR ORIVEWAY.doc (08108) <br />for approximately <br />Contractor's License <br />days, <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN [ s' 7 2 3 3 FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />AREA: <br />QUAD <br />TYPE: <br />FORMS: <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL• <br />INDUSTRIAL: <br />@ RIW <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: <br />Ft. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the <br />side of approximately feetlmile <br />Of by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />INill this project be self -installed? ��"�I YES NO <br />P:IENCROACHMEIJTSIMasler Fortnr.-TempialeslENCROACHh1EM PERMR ORIVEWAY.doc (08108) <br />for approximately <br />Contractor's License <br />days, <br />Work will <br />