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OUNTY OF SAN JOAQUIN <br />ARTMENT OF PUBLIC WORKS <br />DRIVEWAY & PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Name <br />7/ s V <br />Address <br />,U�o,�� . C 4 .tel' 3 Z 3 a <br />City, State - Zip Code <br />_ — -!;-S 54 O / SL JF <br />(Area Code) Telephone <br />SITE INFORMATION <br />Parcel Owners Name <br />Zg:7 lc t f 5. 1lc536t--� V <br />Site Address <br />City, St e - Zip Code <br />(Area Code) Telephone <br />CONTRAC' <br />Name <br />Address <br />City, State - Zip Code <br />(Area Code) Telephone <br />•Date: <br />Received by <br />CR# / o <br />DRIVEWAY <br />TYPE QUANTITY WIDTHS <br />AGRICULTURE I/ @ FRONTAGE <br />COMMERCIAL <br />INDUSTRIAL @ RNV <br />RESIDENCE <br />PAVED FRONTAGE <br />LENGTH: Ft. X WIDTH: Ft. <br />The undersigned hereby applies for permission to encroach <br />on County Hig ay Right -of -Way on the side of <br />. ;1!5� - approximatet <br />feet / mile of _ ),,T►, Fe <br />by installing <br />Work will commence on or about for approximately days. <br />(Separate sheet may be <br />a000000, <br />1011110000**� <br />Will this project be self -installed? NO YES Contractor's License <br />