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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Name: <br />Address: <br />City, State, Zip Code: <br />Area Code - Telephone Number::. ocj <br />SITE INFORMATION: <br />Parcel Owner's Name: -; ,�, ti1. �� -7 r <br />Site Address: <br />City, State, Zip Code: �){c/1 j <br />Area Code - Telephone Number: zQ 9 <br />CONTRACTOR <br />Name: <br />Address: <br />City, State, Zip Code: <br />Area Code -Telephone Number: <br />Date: <br />Received By <br />a <br />CR#:'o9/�" <br />fP5 -1400,7r,2- <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the <br />_Y(i A �— side of 7 -.KL -)j1- Rose (= hip approximately 4 ^ feet/mile <br />of S -t- 9 + ! q 1E 61- � , by installing Z <br />Work will <br />commence on or about for approximately days. <br />M:ICENTRALSERVICESICLERICALIPU&SV.WK%MASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />OFFICE USE ONLY <br />JOB #: <br />APN �>=7� <br />EXP. DATE: <br />STREET: <br />AREA: <br />TYPE: Z <br />FORMS: <br />11005 ISSUE DATE: <br />—� Z FEE DUE: <br />DRIVEWAYS: <br />(,-I P . <br />QUAD <br />QUAD <br />17v I V�iy <br />NOTES: <br />DRIVEWAY <br />TYPE: QUANTITY WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />@ R/W <br />RESIDENCE: <br />L <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: Ft. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Right -of -Way on the <br />_Y(i A �— side of 7 -.KL -)j1- Rose (= hip approximately 4 ^ feet/mile <br />of S -t- 9 + ! q 1E 61- � , by installing Z <br />Work will <br />commence on or about for approximately days. <br />M:ICENTRALSERVICESICLERICALIPU&SV.WK%MASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />