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COUNTY OF SAN JOAQUIN <br />Qg-24010$5 DEPARTMENT OF PULIC WORKS <br />Date: il�l�_4 <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Name: <br />Address: <br />City, State, Zip Code: <br />Area Code - Telephone Number: <br />Email: <br />SITE INFORMATION: <br />Parcel Owner's Name: 1y 4J ) VAA,?c»y <br />Site Address: q?z)4 a?50 -44Ad ^-r'�� <br />City, State, Zip Code:AC,41 fP& IeAj <br />Area Code - Telephone Number: ' <br />CONTRACTOR <br />I Name: dVfJ,�,L�.J2- d;B.25srJ-7>0�? <br />Address: ", 41L /= fF°T iYd� <br />City, State, Zip Code: <br />Area Code -Telephone Number: g4e2, <br />Received By: 'lk <br />CR#: 2 2 649 U I <br />OFFICE USE ONLY <br />JOB #: 11005 ISSUE DATE: <br />APN FEE DUE. <br />EXP DATE, DRIVEWAYS: <br />STREET: 43gq Z.1A-an I RA <br />AREA: iI tixyn h QUAD <br />TYPE: nw A, <br />FORMS: cvl4lr�3 P__r1 <br />NOTES: <br />I DRIVEWAY <br />TYPE: <br />AGRICULTURE: <br />COMMERCIAL. <br />INDUSTRIAL. <br />RESIDENCE: <br />I <br />LENGTH: <br />QUANTITY <br />x 'L <br />PAVED FRONTAGE <br />Ft. X WIDTH: <br />WIDTHS <br />a(�FRONTAGE <br />RIW <br />Ft. <br />The undersigned hereby applies far permission to excavate, construct and/or otherwise encroach on County Hi hway Ri ht-of-Way on the <br />lwaevI sideof._approximately t�LSR f_ mile <br />Of aru&lla R i , by installina <br />Work will <br />commence on or about for approximately <br />SKETCH (Separate sheet maybe submitted) <br />days. <br />Will this project be self -installed? YES NO Contractor's License q�c)" <br />%�EIVCROACNME�1isIAlaele'Fo,ms templaleslEHcgoACHMF.�RPERM11q egIVEWRYtlav�001007 <br />