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COUNTY OF SAN JOAQUIN Date: 7 <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: T/",I <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 52 0 36 <br /> APPLICANT OFFICE USE ONLY <br /> me: ti n;r <br /> dress: Z 0J 0,J JOB#: 11005 ISSUE DATE: <br /> State,Zip Code: Mc, A f APN FEE DUE: <br /> .a Code -Telephone Number: , ')f 6 -31?67 EXP.DATE: ( - DRIVEWAYS: <br /> STREET: AIASf <br /> SITE INFORMATION: AREA: < QUAD <br /> cel Owner's Name: KZ�5 WJ 6,aw, IwG_4AJ TYPE: (yn/1m eimct <br /> 'Address: ,f FORMS: <br /> f,State,Zip Code: NOTES: <br /> a Code -Telephone Number: 6T <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> ne: ��- AGRICULTURE: @FRONTAGE <br /> gess : COMMERCIAL: <br /> ,State,Zip Code: INDUSTRIAL: @ RMI <br /> 3 Code -Telephone Number: RESIDENCE: <br /> i <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> -he undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highwa Right-of-Way on tha <br /> rA) � side of approximately 1_ —fe mile <br /> f t-3 r---3-z- \'iZr`1 by installing Cz)✓v)rti A j <br /> Work will <br /> )mmence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> j�� y4`Tt-vrCt1-£� <br /> I this project be self-installed? ,YES NO Contractor's License <br /> NTRALSERVICESICLERICALIPU&SV.WKUASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09/13) Page 1 of 2 <br />