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COUNTY OF SAN JOAQUIN Date: 2 <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: T6 <br /> DRIVEWAYS AND PAVED FROTTAGES <br /> PERMIT APPLICATION CR#: 535 13 <br /> APPLICANT OFFICE USE ONLY <br /> Name: /� t� <br /> Address: O 4, 1,1 JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: APN � FEE DUE: <br /> Area Code -Telephone Number. c5 di' EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: Dea 14oL QUAD - <br /> Parcel Owner's Name: TYPE: <br /> Site Address: ��-4 191?lez-11-0 FORMS: <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Num <br /> DRIVEWAY. <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: % DUSTRIAL: @RNV <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Hi hway Right-of-Way on the <br /> side of lt� / approximately ee ile_ c <br /> Of IAlei A),L- ,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 /> A.*XCENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />