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COUNTY OF SAN JOAQUIN Date: ( 0- 2/- /,51- <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: T LI—a <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: S 7— <br /> 5 <br /> 403056 <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: JOB#: 11005 ISSUE DATE: <br /> f <br /> City,State,Zip Code: �, �� �• �� APN 107 030 O FEE DUE: <br /> Area Code -Telephone Number:` r n ' EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: L4 U Ian QUAD <br /> Parcel Owner's Name: TYPE: SFR <br /> Site Address: FORMS: !7 <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: © —yq AGRICULTURE: T(C_�FRONTAGE <br /> Address: '1 S, COMMERCIAL: <br /> City,State,Zip Code: - INDUSTRIAL: @ RM <br /> Area Code -Telephone Number: RESIDENCE: ( �S <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to ggxcavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> _41 side of — - e (0 approximately 2,C feet/mile _ <br /> of 11 9— 44 1 y Q rca q, f f <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:\CENTRALSERVICEaCLERICAL\PUB-SV.WKWASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (091131 Page 1 of 2 <br />