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COUNTY OF SAN JOAQUIN Date: 1 - -)tq <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: � <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> C r for �j ((k(4P PERMIT APPLICATION¢ CR#: 5 2 6 <br /> ( T- / 0 <br /> APPLICANT OFFICE USE ONLY <br /> Name: - br <br /> Address: (gyp 0 ' JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: & NoPP CA APN 7-p7 'Z2.Q p 3 FEE DUE: <br /> Area Code -Tele hone Number: 3 0— EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: QUAD <br /> Parcel Owner's Name: TYPE: Zx r) <br /> Site Address: a 5) RD FORMS: �/ 7 <br /> City,State, ip Code: b NOTES: <br /> Area Code -Telephone Number: 53o- - -g3( <br /> ons;kc DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: u G AGRICULTURE: @FRONTAGE <br /> Address: 3 5 COMMERCIAL: <br /> City,State,Zip Code: C GO " INDUSTRIAL: @ RNV <br /> Area Code -Telephone Number: 5, 3 O--±;- —3-9-35- 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 feet/mile <br /> of 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 U 1 <br /> M:ICENTRALSERVICESICLERICALIPUB-SV.WKWASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />