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• COUNTY OF SAN JOAQUIN Date: 9-16- I� <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: 'r C <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> J7 - 4Z4- <br /> APPLICANT OFFICE USE ONLY <br /> Name: d I' <br /> Address: JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: L o d i Y5 14( APN 0 G( 030 G'7 FEE DUE: <br /> Area Code -Tele hone Number. - of( 3 EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> C4 11 <br /> SITE INFORMATION: AREA: r1 : QUAD NL' <br /> Parcel Owner's Name: TYPE: ���� Mee r 1 <br /> Site Address: FORMS: /Z <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY. <br /> CONTRACTOR TYPE: QUXNTITY 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 ermission to excavate,construct and/or otherwise encroach on County Hi hway Right-of--Way on the <br /> 1ecst- side of a� �r ,�QO�I approximately _2�3�Jn v ile <br /> of—,:Ili <br /> a rn cam(^n by installing -I—v rnN,01 pe r=cA l <br /> Ara <br /> Work will <br /> commence on or about for approximately days. <br /> SKETC (Separate sheet ay be submitted) <br /> Will this project be self-installed? YES NO Contractor's License <br /> M:\CENTRALSERVICES\CLERICAL\PU&SV.WMMASTER.PS\ENCROACHMENT PERMCC DRIVEWAY.DOC (09113) Page 1 of 2 <br />