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y Coto COUNTY OF SAN JOAQUIN Date: 3 417 J <br /> ,Ioq- 110C- 1731 DEPARTMENT OF PULIC WORKS <br /> Received By: WA�_ <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: MOO <br /> APPLICANT OFFICE USE ONLY <br /> Name: >ct{.3 i►1E1t1 it <br /> Address: L; -,L lMlocl{'u A JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: q 2-i2 APN i7q-I&O-2o FEE DUE: <br /> Area Code -Tele hone Number: -vc1 "hL 17 S I EXP.DATE: DRIVEWAYS: <br /> STREET: /VIA)21'PobW 0. <br /> SITE INFORMATION: AREA: .51'4,_-�Al QUAD 5b <br /> Parcel Owner's Name: . K\A aLP, S;;AQOA ANIL- TYPE: <br /> Site Address: o�o FORMS: <t <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number: c)aq& 1-73 <br /> DRIVEWAY <br /> - - - CONTRACTOR -- - TYPE------ - - _ ._ QUANTITY WIDTHS <br /> Name: N AGRICULTURE: 1@FRONTAGE <br /> Address: COMMERCIAL: <br /> j <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 appli s for permissio to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> side of 5� approximately 35/ :t feet/mile zVW <br /> of o , aac,C! �, by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> P4414 zX FA- 13004--68(5-4) <br /> .A�/Will this project be self-installed? YES _NO Contractor's License <br /> M:ICENTRALSERVICES\CLERICAL\PUB-SV.WI<\MASTER.PS\ENCROACHIdENT PERMIT DRIVEWAY.DOC (09113) Pagel of 2 <br />