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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: l,w) <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: S 2 3 <br /> APPLICANT OFFICE USE ONLY <br /> Name: IROAJ ;. <br /> Address: Q Aj- Ulz;67 JOB#: 11005 ISSUE DATE: <br /> Ci ,State,Zi Code: APN ()03-n¢0-()1 FEE DUE: <br /> Area Code -Telephone Numbe EXP.DATE: - �-=L5 DRIVEWAYS: <br /> STREET: 2 Cy RIZF <br /> i SITE INFORMATION: AREA: QUAD N <br /> Parcel Owners Name: TYPE: <br /> Site Address: ca N FORMS: <br /> City,State,Zip Code: L ; NOTES: <br /> Area Code -Tele hone Numbr: <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: "f s AGRICULTURE: @FRONTAGE <br /> Address: 4 COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ R <br /> Area Code -Telephone Number: 4 MI <br /> RESIDENCE: I <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned herebyap 'es for p rmiggsion to excavate,construct and/or otherwise encroach on County Highway Ri ht-of- ay on the <br /> FYi�S� sideo zL2=dl- approximately feet/mile,' <br /> of KI 104qC by installing <br /> Work will <br /> commence on or about W for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> _J 00 1 w W Q <br /> Will this project be self-installed? YES NO Contractor's License �J� 73 s' <br /> M.ICENTRALSERVICES!CLERICALIPU&SV.WKIMASTER.PSIENCROACHMENT PERMR DRIVEWAY.DOC (09M) Page 1 of 2 <br />