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COUNTY OF SAN JOAQUIN Date: Ia <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: � <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#:_O 4 c(9�5 U <br /> APPLICANT OFFICE USE ONLY <br /> s: JOB#: 11005 ISSUE DATE: <br /> :ate,Zi Code: APN Ex3-34a- FEE DUE: <br /> ode -Tele hone umber: — 7G EXP.DATE: DRIVEWAYS: <br /> STREET: N)�2S Y C,,,, * <br /> SITE INFORMATION: AREA: Lv K per,,` QUAD <br /> Owner's Name: TYPE; <br /> dress: / p�f FORMS: S S w t <br /> ate,Zip Code-: LI N4 -A NOTES: <br /> )de -Telephone Number. — 7d 42 <br /> DRIVEWAY <br /> _ _.. ----- CONTRACTOR ------- - --- -- --- TYPE.-- -- -- - -QUANTITY- - -- - ----- WIDTHS <br /> AGRICULTURE: @FRONTAGE <br /> COMMERCIAL: <br /> ste,Zip Code: INDUSTRIAL: R/VU <br /> )de -Telephone Numb — RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> undersigned hereby applies for permissio to excavate,construct and/or otherwise encroach on County Hi hway Right-of-Way on the <br /> VM z�,�SAA_ approximately Z�lj' =mile <br /> l S91by installing <br /> Work will <br /> nence on or about for approximately days. <br /> HCH(Separate sheet may be submitted) <br /> lis project be self-installed? YES NO Contractor's License <br /> ZALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />