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COUNTY OF SAN JOAQUIN Date: i'C <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> - 2 <br /> APPLICANT OFFICE USE ONLY <br /> Address: JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: Oc—Vj C,; _ < APN q 3aO l FEE DUE: <br /> Area Code -Telephone Number. Cl ;_ _ .qC,S.. - EXP.DATE: DRIVEWAYS: <br /> STREET: rCA <br /> SITE INFORMATION: AREA: e�,cGf Cp�,� QUAD S <br /> Parcel Owner's Name:—,— <br /> TYPE: <br /> Site Address: C ` FORMS: <br /> City,State,Zi Code:i—�c c�C1� C,. (� ,n NOTES: <br /> Area Code -Telephone Number:C`1 Y c <br /> DRIVEWAY. <br /> CC N-TRA TOR — TYPE: QUANTITY WIDTHS <br /> Name: —47_p�v\ �Zt�_ nEF�—�- `J AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: :DC�C 1,::�-kUCA`7 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 approximately �kx fee mile <br /> of 4 42t 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:\CENTRALSERVICES\CLERICAL\PU&SV.WK\MASTER.PS\ENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />