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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By-. <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: tj-K <br /> APPLICANT OFFICE USE ONLY <br /> Name: a <br /> Address 5 r l �. s JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: APN LK-00 - 17 FEE DUE: <br /> Area Code -Telephone Number: Z u U Z" EXP.DATE: DRIVEWAYS: <br /> STREET: g5A-5Men! #616-4T's ED. <br /> SITE INFORMATION: AREA: Li,vpE11 QUAD A16 <br /> Parcel Owner's Name: TYPE: 1pW <br /> Site Address: z1 '3-73 c - ORMS: <br /> City,State,Zip Code: 4-f"h Cy cl NOTES: <br /> Area Code -Telephone Number: Z o 4 , <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: /'Y'l AGRICULTURE: @FRONTAGE <br /> Address: P,a' 6 to COMMERCIAL: <br /> City,State,Zip Code: Z�te @ RV <br /> Area Code -Telephone Number: i s 9 G 3'o RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,con truct and/or otherwise encroach on County Hi way Right-of-Way on the <br /> si a of� ti� c approximately fee mile ` <br /> ofjp 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:ICENTRALSERVICES%CLERICAL!PUB-SV.WMMASTER-PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />