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COUNTY OF SAN JOAQUIN Date: l z 113 <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#: e!�4'1,7 � <br /> APPLICANT OFFICE USE ONLY <br /> Name: S" Z_L <br /> Address: iS ZS ,' , etz� CGS(_. SEC l iQ JOB#: 11005 ISSUE DATE: <br /> O City,State,Zip Code: 5 ,-�'' z of�(� APN D$3-&kfp./2- FEE DUE: <br /> Area Code -Tele hone Numbe. g -?r)-Z ~E t4 EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: 40PI/ QUAD <br /> Parcel Owner's Name: LLC TYPE: <br /> Site Address: /q,, S z L FORMS: w _ <br /> City,State,Zip Code: Z NOTES: <br /> Area Code -Telephone Nurrber: .7� <br /> DRIVEWAY <br /> - - - - CONTRACTOR- -- - - TYPE ---- QUANTITY— WIDTHS _ <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: ,lr <br /> City,State,Zip Code: INDUSTRIAL: @ RMI <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Thendersigned hereby appl�ije�for permission to excavate,construct and/or otherwise encroach on Coun�Hiay Right-of-Way on the <br /> sideof Z77=y,24ke / ,A/4 approximately 2oe�r� j��s7 <br /> of uLG Y go 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? 1- YES NO Contractor's License <br /> M:ICENTRALSERVICESICLERICAL\PUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />