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COUNTY OF SAN JOAQUIN Date: '2--Z�— S <br /> DEPARTMENT OF PULIC WORKS _ <br /> Received By: <br /> DRIVEWAYS AND PAVED FROTTAGES <br /> PERMIT APPLICATION CR#: S 3 V O <br /> APPLICANT OFFICE USE ONLY <br /> Name: 5 o J C. <br /> Address: `10,*JE 7, JOB#: 11005 ISSUE DATE: <br /> City,State,Zi <br /> p Code: W-1F,1 APN Z Z"Q ( I -7 FEE DUE: <br /> �� <br /> Area Code -Telephone Number: (91 EXP.DATE: DRIVEWAYS: <br /> STREET: Ck C k TU <br /> SITE INFORMATION: AREA: C oe ercY--C> /I S Q AD S C <br /> Parcel Owner's Name: TYPE: TW " <br /> Site Address: 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: 150 �Xlsfin d iso <br /> City;State,Zip Code: INDUSTRIAL: @ RIW <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The under igned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> side of JCC C k, approximately aSr9D feet/mile S <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:ICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />