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COUNTY OF SAN JOAQUIN Date: eqT S <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRUN'1AGES <br />PERMIT APPLICATION <br />Received By: <br />APPLICANT <br />JOB #: <br />Name; <br />APN IS .370.(o FEE DUE: <br />e., <br />Address:—2'5;0 a�; <br />4r i <br />lv <br />City, State, Zip Code: <br />4,, . <br />TYPE: <br />Area Code - Telephone <br />Number: <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />TYPE: <br />Site Address: S <br />s <br />AGRICULTURE: <br />City, State, Zip Code: <br />FRONTAGE <br />- <br />Area Code - Tele hone <br />Number: <br />/ —6e5 z <br />RIW <br />CONTRACTOR <br />Name: <br />ei <br />LENGTH: <br />Address: <br />City, State, Zip Code: <br />3 3 <br />Area Code <br />-Telephone <br />Number: <br />_ y' <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 />�( Will this project be self -installed? <br />for approximately <br />YES NO Contractor's License <br />P:IENCROACHIA�PITSIMaster Forms-TeRglalaslENCROACHMEM PERMR ORIVEV/AY.doc (08/08) <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE; <br />APN IS .370.(o 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: Fte <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 />�( Will this project be self -installed? <br />for approximately <br />YES NO Contractor's License <br />P:IENCROACHIA�PITSIMaster Forms-TeRglalaslENCROACHMEM PERMR ORIVEV/AY.doc (08/08) <br />days. <br />Work will <br />