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COUNTY OF SAN JOAQUIN <br />&PARTMENT OF PUBLIC WORKS <br />DRIVEWAY & PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />J 7 (,') /A/ C <br />_ Name <br />Address <br />zC)wt,7,,, "9— y L/ <br />City, State - Zip Code <br />(Zei) qj�z-- n 9 <br />(Area Code) Telephone <br />SITE INFORMATION <br />Parcel Owners Name <br />Site Address <br />City, State - Zip Code <br />C2o, T4f d9 -/ 7q- y <br />(Area Code) Telephone <br />CONTRACTOR <br />Name <br />Address�� <br />City, State - Zip Code <br />q q/ -6z--- 0 f F% <br />(Area Code) Telephone <br />Work will commence on or about <br />sheet may be <br />I I <br />A <br />Date: q / /Q / `7 — <br />Received byP� <br />CR#1 7073 72 <br />DRIVEWAY <br />TYPE: QUANTITY WIDTHS <br />AGRICULTURE @ FRONTAGE_ <br />COMMERCIAL <br />INDUSTRIAL G RNV <br />RESIDENCE <br />PAVED FRONTAGE <br />LENGTH: Ft. X WIDTH: Ft. <br />The undersigned hereby applies for permission to encroach <br />on County Highway Right -of -Way on the Qn u & side of <br />cop -19I ic ac IN -D approximately <br />U -D feet --.mile C—MT of llj� <br />, by installing <br />for approximately <br />r <br />Cr <br />Will this project be self -installed? NO YES Contractor's License �Z= <br />days. <br />