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COUNTY OF SAN JOAQUIN Date: S S 4— <br /> DEPARTMENT <br /> OF PULIC WORKS <br /> Received By: T <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: Cl; 13 0 <br /> ALLtic 5 � (4( Iz461 <br /> APPLICANT OFFICE USE ONLY <br /> ss: (i 0,f <br /> JOB#: 11005 ISSUE DATE: <br /> Rate,Zi Code: (un A 1 c� APN ZZ° 1 FEE DUE: <br /> erode -Telephone Number: Zv 6 -C-a %2N-7 v EXP.DATE: S Z I/li; DRIVEWAYS: <br /> STREET: 'belw-V j? <br /> SITE INFORMATION: AREA: QUAD S <br /> I Owner's Name: + vvr�. �. ' Lke TYPE: — <br /> ddress: 118 FORMS: -f <br /> 'tate,Zip Code: aS c- (,e), r: 0 NOTES: <br /> ;ode <br /> Telephone Number: 6 rel <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> AGRICULTURE: @FRONTAGE <br /> 5s: COMMERCIAL: <br /> tate,Zip Code: INDUSTRIAL: @ RIW <br /> ,ode -Telephone Number: RESIDENCE: ( z 5 <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> ndersigned hereby appli for per si n to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> side of pp f_ i A ��� approximately feet/mile <br /> i,ovo. 'Vee_ . J by installing 05:61nkl-E' J 7:,,vi <br /> Work will <br /> imence on or about • t for approximately days. <br /> (ETCH(Separate sheet may be submitted) <br /> L(�;ne. Svc e <br /> r <br /> fgkA Ct�ren <br /> this project be self-installed? YES NO Contractor's License <br /> TRALSERVICES\CLERICAL\PUB-SV.WK\MASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />