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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#:0-<00 t <br /> APPLICANT OFFICE USE ONLY <br /> Name: e <br /> Address: j fq c;Ly JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: IrV/ - APN G�5 /��� �T FEE DUE: <br /> Area Code Telephone Number:209 33,q EXP.DATE: - DRIVEWAYS: <br /> STREET: <br /> SI INFORMAT N: AREA: QUAD N� <br /> Parcel Owner's Name: TYPE: o <br /> Site Address: `��2 (�c ? �z> r3l_� FORMS: <br /> City,State,Zip Code: i NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RIW <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for pe 'is ion to ex. te,construct and/or otherwise encroach on County Highway Ri ht-of- ay on the <br /> � �+ s'de of �l' �,r cz��C/ o5,d approximately luo C fe�tlmile <br /> Of �-}W� i by installing CQ0 r r-27(:-7 <br /> Work will <br /> commence on or about aS&2n0 for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> y& Jld1 <br /> fV <br /> N <br /> 1 <br /> Will this project be self-installed? YES NO Contractor's License <br /> M:ICENTRALSERWCESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT ORNEWAYAOC t09113) Page 1 of 2 <br />