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1 COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: .�-- <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 0 Ll Rq% 2-- <br /> APPLICANL OFFICE USE ONLY <br /> Name: <br /> Address: JOB#: 11005 ISSUE DATE: <br /> City,Sfate,Zip Code- Z, APN FEE DUE: <br /> Area Code -Telephone Number: EXP.DATE: DRIVEWAYS: <br /> STREET: Akoy,,py <br /> SITE INFORMATION: AREA: Lowep, QUAD <br /> Parcel Owner's Name: TYPE; ) \�JV_ 6,V <br /> Site Address: FORMS: SS <br /> City,State'Zip Code: NOTES: <br /> Area Code -Telephone Number: 1-7 <br /> DRIVEWAY. <br /> - - --- ----- ----CONTRACTOR---- - ----- ---- -- -TYPE—. ----------- - QUANTITY- - -- - WIDTHS <br /> Name: 1 AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: 7Ae RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Ri ht-of--Way on the <br /> aD( sid�of �'��nt�Tr%tti approximately 7 7 tb` �e�mile <br /> of �. _ ,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? YES NO Contractor's License <br /> M:ICENTRALSERVICEMLERICAL\PUB-SV.WKMSTER.P$IENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page I of 2 <br />