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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> 3 6 Received By: <br /> 3' DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION 6R#: � - 4� <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: Z q N t2 ✓L/ JOB#: 11005 ISSUE DATE: <br /> �j <br /> City,State,Zip Code: IC5-3 C6 APN 21j5' — Z.?,C ' FEE DUE: <br /> Area Code -Tele hone N tuber: Zo 7 EXP.DATE: D IVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: QUADSf, <br /> Parcel Owner's Name: ' c/, TYPE: ���elk <br /> Site Address: p'f vu.� _, /�� FORMS: t <br /> City,State,Zip Code: F_sc C NOTES: <br /> Area Code -Telephone Number: 1 Jay-216r <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: S m� 1i• 1 AGRICULTURE: @FRONTAGE <br /> Address: 2 Al COMMERCIAL: <br /> City,State,Zip Code: C,c- 153 616 INDUSTRIAL: @ RNV <br /> Area Code -Telephone Nu ber: a o fl -5-2} ( RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned herebyapplies for permission to exc vate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> eS <br /> side-ofV� Allam_ approximately L feet/mile fvC7V <br /> of oi12.V , ,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:ICENTRALSERVICEMLERICALIPU&SV.WKIMASTER.PS\ENCROACHMENT PERMrf DRIVEWAY.00C (09113) Page 1 of 2 <br />