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4 If <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />C�RIVEW,AYS AND PAVED FRONTAGES <br />PERMIT APPL IGATIO I <br />APPLICANT <br />Name: 14 446 rLc /,0L <br />Address: 3279&1 <br />1 rp&v Wit <br />City, State, Zip Code: <fvW4Dn t4 &?V Go <br />Area Code - Tele hone Number: ZO'1 <br />SS- o110 <br />SITE INFORMATION: <br />Parcel Owner's Name: ir #' <br />Site Address: 27277 <br />City, State, Zip Code: TrAf.0 <br />Area Code - Telephone Numb : io 4 , S �• <br />CONTRACTOR <br />Name: <br />Address: <br />City, State, Zip Code: <br />Area Code - Telephone Number: <br />0 oy <br />Received By: <br />The undersigned hereby applies for permission to excavate, construct andlor 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 />for approximately <br />Will this project be self -installed? YES _NO Contractor's License <br />P:IEHCROACHMEIJTSIAIasler Farms-Templalas,EitlCROACHMENT PERMIT �RIVEWAY.doc (08100) <br />days, <br />Work will <br />OFFICE USE ONLY <br />� inn <br />J #: <br />11005 ISSUE DATE: <br />APN 2,4 -1q0 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 />R/W <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: Ft, <br />The undersigned hereby applies for permission to excavate, construct andlor 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 />for approximately <br />Will this project be self -installed? YES _NO Contractor's License <br />P:IEHCROACHMEIJTSIAIasler Farms-Templalas,EitlCROACHMENT PERMIT �RIVEWAY.doc (08100) <br />days, <br />Work will <br />