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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> ,_� DRIVEWAYS AND PANED FRONTAGE <br /> 7 �- PERMIT APPLICATION CR#: ej�A�`Zl <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> Address: JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: APN 2 c.7 2 "t FEE DUE: <br /> Area Code -Telephone Number:, , q7 ;�'7_ EXP.DATE: DRIVEWAYS: <br /> cl�l/ STREET:;S <br /> SITE INFORMATION: AREA: QUAD <br /> Parcel Owner's Name: TYPE: <br /> Site Address: 114 o515 FORMS: <br /> City,State,Zip Code: ,, q (f, 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: @ R/W <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> T under igned hereby applies f f permission to excavate,construct and/or otherwise encroach on County&eiwcilej <br /> y Right-of-Way on the <br /> 2�� side of GS i approximately loc `;ir��, <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:ICENTRALSERVICESkCLERICAL\PUB-SV.WK\MASTER.PS\ENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />