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COUNTY OF SAN JOAQUIN Date: C ` <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: � <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 5 Z Sl U <br /> APPLICANT OFFICE USE ONLY <br /> Name: c cq e <br /> Address: 9710-) ZUeLijetyK _ JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: C c) APN !S 3- FEE DUE: <br /> Area Code -Telephone Number: Lgoq_ G 6,9 EXP.DATE: DRIV-WAYS: <br /> I STREET: _ <br /> SITE INFORMATION: AREA: AD <br /> Parcel Owner's Name: TYPE: OA <br /> Site Address: `e � FORMS: <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RMI <br /> Area Code -Telephone Number: 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 ofapproximately2 'I-- <br /> 6f . 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:ICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113} Page 1 of 2 <br />