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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: C.1:!S]o <br /> APPLICANT OFFICE USE ONLY <br /> Name: t[9 <br /> Address: !(, LA-9 ' JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: 1,2 C _i G —1 .-v APN j .,Zt,� _. FEE DUE: <br /> Area Code -Telephone Number: EXP.DATE: DRIVEWAYS: <br /> �r STREET: KI <br /> SITE INFORMATION: AREA: h QUADS <br /> Parcel Owner's Name: lyl cvU TYPE: tT7rw X <br /> Site Address: 16' yp FORMS: <br /> C4,State, ip Code: g L -0 NOTES: <br /> Area Code -Telephone Number. Ll <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: _J , Ab V <br /> j/t14z—,.f Ve,4 e r 5j', AGRICULTURE: @FRONTAGE <br /> Address: , _ �y COMMERCIAL: <br /> City,State,Zip Code: 5-fzp CK h9 L d INDUSTRIAL: @ RNV <br /> Area Code -Tele hone Number: `— S p RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permiss' n to excavate,construct and/or otherwise encroach on County Highway Ri ht-of--Way on the <br /> side of approximately IWO/ smile OeAf <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:ICENTRALSERVICESICLERICALTUB-SV.MMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC {09113) Page 1 of 2 <br />