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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: T C <br /> DRIVEWAYS AND PAVED FROTTAGES <br /> PERMIT APPLICATION CR#: f Z 7 3 S <br /> APPLICANT OFFICE USE ONLY <br /> Name: b EC T 1.U 10V TM inns <br /> Address: L/Y y M O S•s AI-C6 JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: &A-r m R APN Z of 0.30 0� FEE DUE: <br /> Area Code -Telephone Number: / j1- $ f EXP.DATE: I? -? - I S DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: L � QUAD S <br /> Parcel Owner's Name: TYPE: �x <br /> Site Address: Wfy mojsc FORMS: <br /> City,State,Zip Code: +Y NOTES: <br /> Area Code -Telephone Number: y /2f <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: V^IA44 �A p4c AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: Z <br /> City,State,Zip ode: AT I N U / INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: 0 RESIDENCE: <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 Highway Right-of-Way on the <br /> "✓ side of ./10 approximately ZOO feet/mile_ Al <br /> of H y 0 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:ICENTRALSERVICESICLERICAUPU6-SV.WKWASTER.PSIENCROACHMENT PERMIT DRVEWAY.DOC (09113) Page 1 of 2 <br />