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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS ANIS PAVED I EKUN I ACES <br />PERMIT APPLICATION <br />Received by: <br />APPLICANT <br />Name: <br />L (Z W <br />Address: 21 <br />44 5 NfLW So liN R4 <br />City, State, Zip <br />Code: J,(J Soy <br />_ <br />Area Code -Telephone Number: 2 — ' <br />Se•S v. �, <br />SITE INFORMATION: <br />Parcel Owner's <br />Name:.ftPA L R RhA MUM <br />Site Address: <br />Z.1 %4 S VCA; Sf37wu <br />City, State, Zip <br />Code: �iQACYI rA 304 <br />Area Code - Telephone Number: cn 6z4 — <br />DRIVEWAY <br />CONTRACTOR <br />Name: <br />Address: <br />WIDTHS <br />City, State, Zip <br />Code: <br />Area Code "Telephone Number: <br />FRONTAGE <br />Received by: <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highvday 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 />l <br />Will this project be self -installed? ��YES NO <br />P:IENCk0ACH6SENT5 Wasler FormsdemplaleslEIJCRCACH6SENT PEP,IdR NRIVEIVAI'.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 > �y <br />�l� FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: ov` <br />Se•S v. �, <br />AREA: <br />pcy QUAD S �.�j <br />TYPE: p" <br />4"AAKA ee <br />FORMS: Si <br />t .4 <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: - <br />FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />R/W <br />RESIDENCE: <br />ie <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 Highvday 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 />l <br />Will this project be self -installed? ��YES NO <br />P:IENCk0ACH6SENT5 Wasler FormsdemplaleslEIJCRCACH6SENT PEP,IdR NRIVEIVAI'.doc (08108) <br />for approximately <br />Contractor's License <br />days. <br />Work will <br />