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COUNTY OF SAN JOAQUIN Date: g� f <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: � <br /> DRIVEWAYS AND PAVED FRONTAGES �.. <br /> PERMIT APPLICATION! CR#: US <br /> APPLICANT OFFICE USE ONLY <br /> Name: N/1 c,, n <br /> Address: � S Cc,I; rn JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: APN $o `(v� FEE DUE: '�:!l Z <br /> Area Code -Telephone Num r: zo c) - c�/ - 6 y 7 EXP.DATE: DRIVEWAYS: <br /> j STREET: <br /> SITE INFORMATION: AREA: -F QUAD,--SO,,-1 <br /> Parcel Owner's Name: ryleft I---riq Ll TYPE: '0 C-�/S <br /> Site Address: r,; i e FORMS: (,vt <br /> City,State,Zip Code: Tr,�c-, C A 9S 0LI NOTES: r <br /> Area Code -Telephone Number: <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITYWIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: Uu U COMMERCIAL: <br /> City,State,Zip Code: } CA !;-36 INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: Zoc - 12 —-7279 RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby ap lies for permission to excavate,construct and/or otherwise encrq ch on County II way Ri ht-of-Way on the <br /> side of ti� -" Y-4-Lk V approximately t mile A <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:ICENTRALSERVICES%CLERICAL%PUB-SV.WKUAASTER.PSIENCROACHMENT PERMrr DRIVEWAY.DOC (09113) Page 1 of 2 <br />