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COUNTY OF SAN JOAQUIN Date: - ( 7 ( k- <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: -C <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 3 <br /> APPLICANT OFFICE USE ONLY <br /> Name: f tL��1�l 45*:cc, Fiat,t 'Chr-a�"! <br /> Address: 1 2'— " �"-clV,t�w4 i•-r JOB#: 11005 ISSUE DATE: <br /> �° Pr -- APN FEE DUE: <br /> City,State,Zip Code: �S'-�,�;t";,�-�r3 4• ' �-B- ®.�:.-��:� f 32 � OS�-U`l <br /> Area Code -Telephone Number: ��r�<_f,,.,�. ,-,� EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: 5±0C k4op QUAD ,A( <br /> Parcel Owner's Name: TYPE: _4 011103er-rioLl <br /> Site Address: >_- =F� d �r` = FORMS: 5 '7 <br /> City,State,Zip Code: CA�: &T- C i- :S=�W`� NOTES: '' �� ►3 125 <br /> Area Code -Telephone Number: 15- <br /> DRIVEWAY. <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: "I t'L;i! �;� � ;z; Ave AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL <br /> City,State,Zip Code: `�-���c:,-=3t3� r_�-� ;a�� ' INDUSTRIAL: @RMI <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applie for permission to excavate,construct and/or otherwise encroach on County Hi way Right-of-Way on the <br /> side of �c Teepee approximately 15 O0 ee ile <br /> Of ki g'r <br /> a.LC e 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:\CENTRALSERVICES\CLERICAL\PUB-SV.WKWASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />