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COUNTY OF SAN JOAQUIN °� Date: <br /> 2G� DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION Mt. <br /> APPLICANT OFFICE USE ONLY <br /> Name: to ►� C v ✓L2 <br /> Address: o -, JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: v ,,,, APN �'l —u►o— L FEE DUE: <br /> Area Code -Tele hone Number: EXP.DATE: T` DRIVEWAYS: <br /> STREET: ►� <br /> SITE INFORMATION: AREA: QUAD <br /> Parcel Owner's Name: TYPE: <br /> Site Address: 5 ( FORMS: SS iA� <br /> City,State,2 ip Code: 20 NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: r _L c '=tk AGRICULTURE: @FRONTAGE <br /> Address: z COMMERCIAL: <br /> City,State,Zip Code: S 7c c :i&/y c-r�, S a INDUSTRIAL: @RNV <br /> Area Code -Telephone Number: RESIDENCE=: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permion to excavate,construct and/or othenivise encroach on County Highway Right-of-Way on the <br /> r SII <br /> r�7T side ofapproximately_�, _ _ <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? Ia NO Contractor's License <br /> M.\CENTRALSERMCESICLERICALIPUMV.WMMASTER.PS\ENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />