Laserfiche WebLink
M <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />©KlVlw.Vl1AYS AND PAVtU IwK)N I AGES <br />PERMIT APPLICATION <br />Received By: <br />�L <br />APPLICANT <br />Name:zz�kA r <br />{t l Inr• <br />Address: <br />70 Z % FEE DUE: <br />City, State, Zip Code: <br />1 , f /�- r7 5 L `-r L <br />Area Code - Telephone <br />Number: '2.a6t — v r,cs- LE1�&Z <br />SITE INFORMATION; <br />Parcel Owner's Name; rCCA vJ L3e0 Cry <br />Site Address: cra it ct. -z <br />City, State, Zip Code; e-0vW eA <br />Area Code Telephone <br />Number; ` o i to "5PI ; <br />FORMS: <br />CONTRACTOR <br />Name: lb eva,•o" i/s.1 a. a.V nroA-A vAte, xvu. ,,00z:1W Xr-Lc.. <br />Address; d j Sqp� <br />5 � ' <br />City, State, Zip Code; <br />CA 9S Eg <br />Area Code - Telephone <br />QUANTITY <br />WIDTHS <br />Number: <br />'b t" tmSZ <br />Received By: <br />�L <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Righf-of-Way on the <br />_ side of GoL.164 v2 approximately feet/mile FR3T <br />of 4 i)Arm m L*E+Jct by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />Will this project beself-installed? YES ,/� NO Contractor's License �� � � 3 �- <br />P:IEWCROACHN,ENTSNIacler Fomes-TeinpldeslENCROACHhIEM PERMIF DP.IVEVIAY.doc �OAIJB) <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #; <br />11005 ISSUE DATE: <br />APN 01S -3 <br />70 Z % FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />�a V:lr> <br />AREA: oko! <br />QUAD f�E <br />TYPE: <br />FORMS: <br />VJ <br />(VOTES: <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 and/or otherwise encroach on County Highway Righf-of-Way on the <br />_ side of GoL.164 v2 approximately feet/mile FR3T <br />of 4 i)Arm m L*E+Jct by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />for approximately <br />Will this project beself-installed? YES ,/� NO Contractor's License �� � � 3 �- <br />P:IEWCROACHN,ENTSNIacler Fomes-TeinpldeslENCROACHhIEM PERMIF DP.IVEVIAY.doc �OAIJB) <br />days. <br />Work will <br />