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r <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Name: ,r <br />Address: Po /Soy q' <br />City, State, Zip Code: 6�creS CA ''s367 <br />Area Code Telephone Number: ' OSI -0'OLI-(v <br />SITE INFORMATION: <br />Parcel Owner's Name: Chc� Lc� S r p Kc)viti <br />Site Address: 6 70 kf r oke <br />City, State, Zip Code: lLo c(l c' G.A- f!�7a.Ll a - <br />Area Code - Tele hone Number: <br />CONTRACTOR <br />Name::' <br />Address: <br />City, State, Zip Code: <br />Area Code - Telephone <br />Number: <br />DRIVEWAY <br />Date: <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 feetlmHe <br />of _ by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />Will this project be self -installed? _YES <br />P:IEfJCRCACHNENTSIMasler FarmsTemplaleslEIJCRDACHtdENT PERN.R DRIVEVJAI'.doc (03108) <br />for approximately <br />days. <br />M�fa I gaffe <br />Work will <br />NO Contractor's License <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE; <br />APN :03 S ZSd U 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 feetlmHe <br />of _ by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />Will this project be self -installed? _YES <br />P:IEfJCRCACHNENTSIMasler FarmsTemplaleslEIJCRDACHtdENT PERN.R DRIVEVJAI'.doc (03108) <br />for approximately <br />days. <br />M�fa I gaffe <br />Work will <br />NO Contractor's License <br />