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COUNTY OF SAN JOAQUIN Date: I Z�!d 13 <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: 5°-- <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: c;?5-O 1 �33 <br /> ^ , <br /> APP CANT OFFICE USE ONLY <br /> Name: C-4P— <br /> Address: lcc ✓t JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: C'k, S` 6 0 APN ug_I Op_o'7 FEE DUE: <br /> Area Code -Tele hone Num er: EXP.DATE: DRIVEWAYS: <br /> STREET: OL-1 V6 A JE, <br /> SITE INF RMATION: AREA: P-4 tO 1J QUAD J <br /> Parcel Owner's Name: TYPE: wJ <br /> { Site Address: Z.l '3 /✓6A&14 L<41 I FORMS: /,,old (Z- <br /> City, <br /> Ci ,State,Zip Code: p, ri ra qs3c-o- NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> --- - --CONTRACTOR - - - - TYPE -- -- ---- QUANTITY -- - -- WIDTHS <br /> Name: 1110CAJ^-e-,c e AGRICULTURE: ,X z @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ R/W <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 County Highwa Right-ppf-Way on the <br /> side of 04-141E Arra approximately <br /> of ,by installing s <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project beself-installed? YES NO Contractors License <br /> M:ICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />