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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Mut �d; o �j f9� I Received By: T <br /> I DRIVEWAYS AND PAVED FRONTAGES <br /> Ol Crs�.[�d / PERMIT APPLICATION CR#: S 1 <br /> P - I1FU( ~� 7 <br /> APPLICANT OFFICE USE ONLY <br /> Name: P-44 <br /> Address: / S „ JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: c APN tOY 2-g(2 OS FEE DUE: <br /> Area Code -Tele hone Number: EXP.DATE: DRIVEWAYS: <br /> �9 ~ L-7 —3F3 G STREET: Ad& AV <br /> SITE INFORMATION: y AREA: QUAD <br /> Parcel Owner's Name:Co' ct LLL AA t K ),c q IqTYPE: <br /> Site Address:.5,s- _ S c FORMS: 4/h/ <br /> City,State,Zip Code: cS tyclic- C NOTES: <br /> Area Code -Tele one Number: <br /> DRIVEWAY. <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permissio to excavate,construct and/or otherwise encroach on County Hi hway Right-of-Way on the <br /> . side of�4 �(/ approximately v ee ile_ 1� <br /> of 51j61 4111by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> I <br /> Will this project be self-installed? YES NO Contractor's License <br /> M:ICENTRALSERVICESICLERICALIPU&SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />