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COUNTY OF SAN JOAQUIN Date: (4- <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> PS- ( -00 <br /> APPLICANT OFFICE USE ONLY <br /> a.0L 5'a- <br /> !0 JOB#: 11005 ISSUE DATE: <br /> Ite,Zip Code: 14nJ APN FEE DUE: <br /> de -Tele hone Number: — 1— O(A EXP.DATE: DRIVEWAYS: <br /> STREET: �C21 �p11a V QUAD $F <br /> SITE iNFORMATION: AREA: �1 <br /> 'wner's Name: G TYPE: [o ff,„;per <br /> ress. .0. 60)e_ 0 FORMS: <br /> te,Zip Code: GALbW , GA; 915 o NOTES: <br /> 1e -Telephone Number: <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> )gAqArFfIJ L AGRICULTURE: @FRONTAGE <br /> S COMMERCIAL: Z 4 <br /> .e,Zip Code: 06K,112 G/4. ( INDUSTRIAL: R/W <br /> ie -Telephone Number y M_ 5471—TF&3 RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> ndersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Hi hway Rigit-of-Way on the <br /> side of approximately `ate ___ffe�DlVmile 0 <br /> Zkb4HWAr by installing_OR W <br /> Work will <br /> ence on or about for approximately f l V r=- days. <br /> TCH(Separate sheet may be submitted) <br /> >project be self-installed? YES NO Contractor's License <br /> LSERVICEMLERICALIPUB,SV.WK\MASTER_P&ENCROACHMENT PERMIT ORIVEWAY.DOC (09113) Page 1 of 2 <br />