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COUNTY OF SAN JOAQUIN Date: ( I — (0 <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: ��- <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#:( t 2C2 _ <br /> APPLICANT OFFICE USE ONLY <br /> Name: c S Q <br /> Address: 47 0 ( Y0040 JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: c. ff- APN FEE DUE: <br /> Area Code -Tele hone Number. _ EXP.DATE ':„ a RIVEWAYS: <br /> STREET: uW <br /> SITE INFORMATION: AREA: C r wQUAD <br /> Parcel Owner's Name: TYPE: <br /> Site Address: -; r FORMS: SS /A)tJ <br /> City,State,Zi Code: S To c -r-- NOTES: <br /> Area Code -Telephone Number: f_. �- <br /> DRIVEWAY, <br /> CONTRACTOR .t A-mi TYPE: QUANTITY WIDTHS <br /> Name: - i,W Lk 0 AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: t-* ►S_ c q v INDUSTRIAL.: @ RNV <br /> Area Code -Telephone Number: 5 --O 3 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 /> c=A ' side of (,✓(L 1lAo Th o Ab approximately feet/mile— 11 <br /> Of I-- by installing Co N C-Qc ?� /� <br /> F R ohi s' c kC-E If � v ` r-4S Z 0 f ��'� 7// 0 . <br /> Work will <br /> commence on or about 11 -to —(L for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> �—Will this-project be self-installed? 6F YES _ NO Contractor's License �� S <br /> M.kCENTRALSERVICESICLERICALTUB-SV.WMMASTER.PSIENCROACHMENT PERMIT DRIVEWAYAOC (09113) Page t of 2 <br />