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- ':_2c> <br /> COUNTY OF SAN JOAQUIN Dale: iy . <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: CgS: Ir 1� <br /> APPLICANT OFFICE USE ONLY <br /> Name: —Ar,Iti S T3.o 1,4:Sc, <br /> Address: , 0. (3 JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: 'V f _x(11 C_/1 9 S z �3 APN FEE DUE: <br /> Area Code -Telephone Number: 2,-v q u i-1 6 o.o EXP.DATE: DRIVEWAYS: <br /> STREET: 10k" <br /> SITE INFORMATION: AREA: QUAD NE <br /> Parcel Owner's Name: A P- t<1 S c)-i TYPE: v,�✓Ewe y - z <br /> Site Address: - -T t,:c N s R . FORMS: <br /> City,State,Zip Code: i—o c A 41 5'/-�-t o NOTES: <br /> Area Code -Telephone Number: y, 5-Li I 2 -?.,;;7 <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: S Q. AGRICULTURE: @FRONTAGE <br /> Address: p,o. T,�r>: 3 a COMMERCIAL: .., <br /> City,State,Zip Code: ,, C A '2 w S INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: .o 11 --6;c - Li o p. RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> TLhhee undersigned hereby applies for permissions to xcavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> ' ' approximately <br /> of by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> \ Will this project be self-installed? YES NO Contractor's License <br /> M:ICENTRALSERVICESICLERICALTUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />