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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AIVD PAVEQ FRC}NTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Name: `�'� f' -Z k G <br />Address: � �� I pJ ls� UE <br />City, State, Zip Code: G" EQ, 77Z!:>Z) <br />Area Code - Telephone Number: C3`j <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />Site Address: <br />City, State, Zip Code: <br />Area Code - Telephone Number: <br />CONTRACTOR <br />Name: y <br />w <br />� ��,.c� � <br />Address: <br />City, State, Zip Code; <br />Area Code - Telephone <br />Number: <br />" co <br />Q `— <br />QUANTITY <br />Received By: <br />The undersigned hereby applies for permission to excavate, construct and/or 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 />for approximately <br />Will this project be self -installed? YES !�"�NO Contractor's License <br />P:IENDRDACHMEMTSNIasler irormsdemplaleslENDRDACHh1ENT PERAIR DRNEYJAY.doc (08108) <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN �Q Q7 4'j 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: <br />Ft. 771 <br />The undersigned hereby applies for permission to excavate, construct and/or 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 />for approximately <br />Will this project be self -installed? YES !�"�NO Contractor's License <br />P:IENDRDACHMEMTSNIasler irormsdemplaleslENDRDACHh1ENT PERAIR DRNEYJAY.doc (08108) <br />days. <br />Work will <br />