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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: T C <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: ,5 Z 7 26 <br /> APPLICANT OFFICE USE ONLY <br /> Name: ;I o <br /> Address: JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: •a 6 �l -'2 g APN O1 y us p 51 FEE DUE: <br /> I Area Code -Telephone Number: EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: / ke�Q QUAD <br /> Parcel Owner's Name: t o rl, TYPE: <br /> Site Address: k 3 SL la FORMS: S W�✓ <br /> City,State,Zip Code: Lr- S1;1NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY. <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: C, koll AGRICULTURE: @FRONTAGE <br /> Address: 4.11.E — )0-1 COMMERCIAL: <br /> City,State,Zip Code: ►a S 2 H INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number:` RESIDENCE: I <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroar on County Hi hway Right-of-Way on the <br /> IV side of�rn�d� approximately e mile_1q� <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 <br /> M:ICENTRALSERVICES\CLERICAL\PUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRNEWAY.DOC (09113) Page 1 of 2 <br />