Laserfiche WebLink
U <br />> <br />I� <br />4%e) <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT <br />Name: W <br />Address: 7 5 <br />City, State, Zip Code: M*0651-D <br />Area Code - Telephone Number: 1 <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />Site Address: <br />'_�- <br />City, State, Zip Code: CA I <br />Area Code - Telephone Number: . 1856 <br />CONTRACTOR <br />Name: E <br />Address: <br />City, State, Zip Code: Ty 075,330 <br />Area Code - Tele hone Number: Zol Z ?_ 0003 <br />Date: �._ Z S= Z o 1 y <br />Received By: <br />r <br />CR#: Q5"CXT <br />The and rsigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Ri ht -of -Way on the <br />-side of F�w�r�//��. approximately Lt 0 U 1 feet/mile _ <br />of MGC by installing <br />Work will <br />commence on or about for approximately days. <br />(Separate sheet may be submitted) <br />Will this project be self -installed? YES NO Contractor's License <br />M:\CENTRALSERVICES\CLERICAL\PU&SV.WK\MASTER.PS\ENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />OFFICE USE ONLY <br />JOB #: <br />11005 ISSUE DATE: <br />APN uR-Irw ���'� FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: E }Lys <br />ey P'c <br />AREA: I VrACQUAD <br />TYPE: <br />FORMS: S <br />LVW t <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY WIDTHS <br />AGRICULTURE: <br />@FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />RNV <br />RESIDENCE: <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: Ft. <br />The and rsigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highway Ri ht -of -Way on the <br />-side of F�w�r�//��. approximately Lt 0 U 1 feet/mile _ <br />of MGC by installing <br />Work will <br />commence on or about for approximately days. <br />(Separate sheet may be submitted) <br />Will this project be self -installed? YES NO Contractor's License <br />M:\CENTRALSERVICES\CLERICAL\PU&SV.WK\MASTER.PS\ENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />