Permits & Development - Encroachment(EP)/Driveway(DW) Permits - 2019_Driveway Permits_PS-1901501 thru PS-1902000_ - PS-1901797

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FAI COUNTY OF SAN JOAQUIN DEPARTMENT OF PULIC WORKS DRIVEWAYS AND PAVED FRONTAGES PERMIT APPLICATION Date: i- 26' �! Received By: APPJCANT JOB #: Name: mittn APN �7�.200 FEE DUE: Address: DRIVEWAYS: City, State, Zip Code: S 776h �1 . S G/ Area Code - Telephone Number: % �- SITE INFORMATION: FORMS: Parcel Owner's Name: Site Address: , j ,. 1*u� ? City, State, Zip Code: 457 V^J 49A21 - TYPE: Area Area Code Telephone Number: 7G`! AGRICULTURE: CONTRACTOR COMMERCIAL: Name: INDUSTRIAL: Address: RESIDENCE: City, State, Zip Code: PAVED FRONTAGE LENGTH: Area Code - Telephone Number: Date: i- 26' �! Received By: The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the side of approximately feet/mile of by installing commence on or about for approximately days, Work will Will this project be self -installed? YES NO Contractor's License P:IENCROACHMENTSIMaslcr FormsTemplaleslEWCROACHMEhf1' PERMR ORIVEWAY.doc (OB/00) OFFICE USE ONLY JOB #: 11005 ISSUE DATE: APN �7�.200 FEE DUE: EXP. DATE: DRIVEWAYS: STREET: AREA: QUAD 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 andlor otherwise encroach on County Highway Right -of -Way on the side of approximately feet/mile of by installing commence on or about for approximately days, Work will Will this project be self -installed? YES NO Contractor's License P:IENCROACHMENTSIMaslcr FormsTemplaleslEWCROACHMEhf1' PERMR ORIVEWAY.doc (OB/00)