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COUNTY OF SAN JOAQUIN Date: 7— (7 — I ¢ <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: S I <br /> P>S- 14D -001 <br /> APPLICANT OFFICE USE ONLY <br /> Name: (4 U( f <br /> Address: 3jy-, <br /> JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: /f' 21`2- APN 04S 14 4 FEE DUE: <br /> Area Code -Telephone Number. 'Lo T--6o. -3 2 2 6._ EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: . Leff` QUAD <br /> Parcel Owner's Name: f TYPE: -f <br /> Site Address: I/ $� rA C� FORMS: <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number: fir, <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITYWIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: R/W <br /> Area Code -Telephone Number: RESIDENCE: 'Z <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Hi hway Right-of-Way on the <br /> side of 126L 1415 approximately mile _ <br /> ofr YEN by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> i <br /> 3 <br /> 1 <br /> Will this project be self-installed? YES NO Contractor's License <br /> I <br /> M,%CENTRALSERVICESICLERICALXPUB-SV.WMMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Pagel of 2 <br />