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COUNTY OF SAN JOAQUIN <br />PARTMENT OF PUBLIC WORKS <br />RIVEWAY & PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Name <br />6� <br />Address <br />T•el,f�y . G,4 9 s 3 -7 <br />City, State - Zip Code <br />(Area Code) Telephone <br />SITE INFORMATION <br />Parcel Owners Name <br />Site Address <br />City, State - Zip Code <br />(Area Code) Telephone <br />CONTRACTOR <br />Name <br />Address <br />City, State - Zip Code <br />(Area Code) Telephone <br />• <br />Date: /7 <br />Received by L.>. <br />CR# /D <br />OFFICE USE ONLY: <br />JOB # 11005 <br />ISSUE DATE <br />FEED) <br />EXP DATE <br />DRIVEWAYS <br />STREET <br />AREA <br />TYPE ;ei�l <W..9-` <br /></Mo►cw; <br />16: <br />NOTE:`: <br />NOTE <br />DRIVEWAY <br />TYPE QUANTITY WIDTHS <br />AGRICULTURE @ FRONTAGE <br />COMMERCIAL <br />INDUSTRIAL @ R/W <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 o 047-1,—� side of <br />approximately <br />S0rfeet / ile of G 6fe-h-ee,o uJ! `7 <br />by installing zl5eJ s+ y <br />Work will commence on or about for approximately days. <br />SKETCH (Separate sheet may be submitted) <br />L• i3 n r: � d <br />Will this project be self -installed? NO YES Contractor's License <br />