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COUNTY OF SAN JOAQUIN Date: I �z2 O z014- <br /> DEPARTMENT <br /> 14DEPARTMENT OF PULIC WORKS <br /> Received By: Tt m (a N u lu tl <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> - 13 31) <br /> APPLICANT OFFICE USE ONLY <br /> Address:-7- qjq o -j�, ',)" pJ JOB#: 11005 ISSUE DATE: L <br /> City,State,Zip Code: S APN w 7 Z G04i FEE DUE: <br /> Area Code -Telephone Number: _ ,q bC,1 EXP.DATE: 11 12-v/i.0( f DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: *�� QUAD SF <br /> Parcel Owner's Name -+ c, - >v TYPE: <br /> C Site Address: -' bAA FORMS: <br /> City,State,Zi Code: \q SSC R. NOTES: <br /> Area Code -Telephone Number: - tl <br /> DRIVEWAY. <br /> CONTRACTOR- _ TYPE:- - --- - _ QUANTITY -- -- WIDTHS - <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RNV <br /> Area Code -Telephone Number: 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 Coun!?fee <br /> g ay Right-of-Way on the <br /> So4th _side of �. approximately ile Wza <br /> of r 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? ALYES NO Contractor's License <br /> M.,CENTRALSERVICESICLERICAL\PUB-SV.WKV,AASTER.PS\ENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />