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COUNTY OF SAN JOAQUIN Date: - ¢ <br /> CV, J <<' DEPARTMENT OF PULIC WORKS <br /> 2�(p Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION PA - 14 -4'0 CR#: SZ 4 7S <br /> APPLICANT TL 14 02-JtU OFFICE USE ONLY <br /> Name: 7Z <br /> I Address: 3ov S. W 04 JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: E C,Gt 4 13 APN �g34D <br /> . 2 ( FEE DUE: <br /> Area Code -Telephone Number: Z - !- s''Z EXP.DATE: DRIVEWAYS: <br /> STREET: cA <br /> SITE INFORMATION: AREA: <br /> QUAD <br /> Parcel-Owner's Name: TYPE: <br /> Site Address: 401 3 EZ G fo 5 0 FORMS: <br /> City,State,Zip Code: 44IZ./O Q _ 967 NOTES: <br /> Area Code --Telephone Number:.'— -- <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: L lAfc, AGRICULTURE: @FRONTAGE <br /> Address: coo COMMERCIAL: t <br /> City,State,Zip Code: .13/ INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number:?01- ct2 _ p 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 High <br /> yvay Right-of--Way on the <br /> N12'A7?-1 side of A 1 65 8,0&10 approximately --< 0 ���-' CfeeJfmile <br /> Of k/' by installing <br /> l� t GVC� u <br /> Work will <br /> commence ern or about_ for approximately QA/ days. <br /> SKETCH(Separate sheet may be submitted) N <br /> I <br /> 13 <br /> 1 <br /> k <br /> r aJ., <br /> Will this project be self-installed? _YES NO Contractor's License AQD (IPA `I��G <br /> M:ICENTRALSERVICESICLERICAL\PUB-SV.WKIMASTER.PS\ENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />