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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: T <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> APPLICANT OFFICE USE ONLY <br /> Name: 60 1 11r <br /> Address: Q 61).< yGIsS JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: t,,,q a, APN023-/SD-/S FEE DUE: <br /> Area Code -Telephone Number: q - EXP.DATE: 2-- t(- / 6 DRIVEWAYS: / <br /> STREET: GOR. P-D, <br /> SITE INFORMATION: AREA: Q� gyt c QUAD n/F <br /> Parcel Owner's Name: ri TYPE: 52rAl <br /> Site Address: FORMS: / <br /> City,State,Zip Code: - 64q q NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY, <br /> CO TRACTOR TYPE: QUANTITY WIDTHS <br /> Name: I` AGRICULTURE: @FRONTAGE <br /> Address: cl'3 COMMERCIAL: <br /> City,State,Zip Code: tol lt7) 5LA 3 INDUSTRIAL: @ RIW <br /> ALO <br /> Area Code -Telephone Number: ,I p(p- RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby appliel for p rmission to excavate,construct and/or otherwise en roach on County Highway Right-of-Way on the <br /> side of ,a approximately feet/mile <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:ICENTRALSERVICESICLERICALIPUR-SV.WKWA.STER.PS\ENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />