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COUNTY OF SAN JOAQUIN Date: ? <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: � <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#:�`��{ 9 <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: tN„ JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: APN ��-3 ,_, � FEE DUE: <br /> Area Code -Tele hone Number: I EXP.DATE: DRIVEWAYS: <br /> STREET: IQ-16a <br /> SIJE INFORMATION: AREA: L oUAD /V <br /> Parcel Owner's Name: TYPE: Of t O_ <br /> Site Address: "l"Oy FORMS: <br /> City,State,Zip Code: I 1KI, NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> -- ---- --CONTRACTOR----- --- -- -TYPE: -- -- QUANTITY- --- --- - WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip ode: L -ft INDUSTRIAL: @R1W <br /> Area Code -Tele hone Number: —/ RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby appf s for permission to excavate,construct and/or otherwise encroach on CountyHHi�ighway Right-of-Way on the <br /> �rS side of t RA approximately� � Cfed)t/mile <br /> of Ntt, a`4 C V_% ,by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? 7k2YES NO Contractor's License <br /> M:ICENTRALSERVICESICLERICALIPU&SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />