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COUNTY OF SAN JOAQUIN Date: <br /> • DEPARTMENT OF PULIC WORKS <br /> Received By: Cogs.z <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 6! <br /> APPLICANT OFFICE USE ONLY <br /> Name: g01j7At o Lza YO&-2- <br /> Address: I el o 4- i 3 nfi S f JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: q s-2d.Cv APN FEE DUE: <br /> Area Code -Tele hone Number: ;� _E� S EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: GC. ✓-,--QUAD <br /> Parcel Owner's Name: TYPE: Pa <br /> Site Address: I q 0 12, n+5 r FORMS: <br /> City,State,Zip Code: q s Zo 6 NOTES: <br /> Area Code -Telephone Number: '2-.%`t Z c r <br /> DRIVEWAY.. <br /> TYPE: - - - - QUANTITY - - WIDTHS <br /> Name: CW)f.,( 6utL v L72 AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RAM <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersi ned hereby applies for permission to excavate,construct and/or otherwise encroach on County way Right-of-Way on the <br /> oz. V side of /i2? �{t-t 5`T: approximately fel. <br /> of -5-1 . ,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:ICENTRALSERVICESICLERICALTU6-SV.WKIMASTER.PSIENCROACNMENT PERMIT ORIVEWAY.DOC (09113) Page 1 of 2 <br />