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• COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: 7-1 1 w\ <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: D5 110 6 <br /> Q0 I l <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: JOB#: 1100 ISSUE DATE: <br /> City,State,Zip Code: APN /0 FEE DUE: <br /> Area Code -Telephone Number: _ EXP.DATE: DRIVEWAYS: <br /> STREET: Rict:zc 4,1 <br /> SITE INFORMATI Q N: AREA: 5fio�rzc QUAD 4/F <br /> Parcel Owner's Name: TYPE: nYf I�eWCA <br /> Site Address: OL5 1PL113 FORMS: yy -17 <br /> City,State,Zip Code: 7_ NOTES: <br /> Area Code -Tele hone Number: <br /> DRIVEWAY <br /> Y CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: ;J y, AGRICULTURE: @FRONTAGE <br /> Address: l COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RIW <br /> Area Code -Telephone Number: RESIDENCE: ( 3 <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Hi way Right-of--Way on the <br /> ,�`-°: r�� `— fee ile <br /> = 5 side of Cru approximately 41 r �� <br /> of — r by installing 0 4'\dl <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) u <br /> =; ` <br /> 1 <br /> i <br /> rI f <br /> \- <br /> Will this project be self-installed? YES NO Contractor's License <br /> M:ICENTRALSERVICES\CLERICAL\PUB-SV.WKWASTER.PSIENCROACHMENT PERMIT DRIVEWAY.= (09113) Page 1 of 2 <br />