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I <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRCIN I AGES <br />PERMIT APPLICATION <br />Imo 34K <br />Y <br />Dai:e: ((• l � ' �� <br />Received By: Tc <br />APPLICANT <br />JOB #: <br />Name: <br />APN <br />C2S f EE DUE: <br />Address: 6660Ccs/ J - <br />City, State, Zip Coder <br />C <br />o - <br />Area Code Telephone <br />Number: -� �J %' q i ?6 -; <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />�. eoiv 4 gAfge <br />'7't <br />Site Address: 5:2L60 <br />o v 17A)l <br />�� <br />City, State, Zip Code: <br />6 <br />QUANTITY <br />Area Code - Telephone <br />Number: <br />@FRONTAGE <br />CONTRACTOR <br />Name: q <br />o <br />T@ <br />Address: 16Ze/110p 1' <br />RESIDENCE: <br />Cit ,State, Zi Code: V <br />;Arf ' <br />Area Code <br />Telephone <br />LENGTH: <br />Nu <br />ber: <br />Y <br />Dai:e: ((• l � ' �� <br />Received By: Tc <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 feet/mile <br />of by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />x Will this project be self -installed? <br />P:IENCRDACHMENTSIMasterFarms-TemplaleslENCRDACHMENT PERMR DRIVEWAY.doc (OBI08) <br />for approximately <br />Contractor's License <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN <br />C2S f EE 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 />T@ <br />RIW <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: <br />Ft. <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 feet/mile <br />of by installing <br />commence on or about <br />SKETCH (Separate sheet may be submitted) <br />x Will this project be self -installed? <br />P:IENCRDACHMENTSIMasterFarms-TemplaleslENCRDACHMENT PERMR DRIVEWAY.doc (OBI08) <br />for approximately <br />Contractor's License <br />days. <br />Work will <br />