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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#: S l S 6 S <br /> APPLICANT OFFICE USE ONLY <br /> Name: G 'r Cn C6•r Y`-Q3 P5 i 3 0 Z yY3 <br /> Address: VA v- JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: Mir\ .P,- APN Z 50 i 30 z l FEE DUE: <br /> Area Code -Tele hone Number: - EXP.DATE: DRIVEWAYS: <br /> STREET: F(Ah �CA Q�1 <br /> SITE INFORMATION: AREA: Tim r v QUAD <br /> Parcel Owner's Name: 0r r TYPE: S / <br /> Site Address: FORMS: -17 <br /> City,State,Zip Code:--T 0� NOTES: <br /> Area Code -Tele hone Number: 6 C <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: <br /> RNV <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby a lies for permission to excavate,construct and/or otherwise encroach on County hway Ri ht-of-W yon the <br /> side of 1-�.r�k ch approximately Q O ee mile <br /> Of 1cQ_ 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:ICENTRALSERVICESICLERICALTU&SV.WMMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />