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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PUCK WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By:PERMIT APPLICATION <br /> APPLICA T <br /> Name: p Lti OFFICE USE ONLY <br /> Address: � - <br /> City,State,Zip Code: ' JOB# 11005 ISSUE DATE: <br /> APN a l a-l q t) FEE DUE: <br /> Area Code -Tele hone Number. _ 7 ., <br /> ��' EXP.-DATE: �— <br /> STREET: DRIVEWAYS: <br /> SI E INFORMATION: AREA: <br /> Parcel Owner's Name: UAD_ <br /> Site Address: TYPE: - <br /> Ci ,8fate,Zi Code: FORMS:Area Code -Tele hone Number: NOTES: <br /> CONT CTOR ' pRIVEWAY. <br /> Name: TYPE: QUANTITY <br /> Address: AGRICULTURE: WIDTHS <br /> Ci ,State, i Code: c COMMERCIAL: -FRONTAGE <br /> Area Code -Telephone Number: c INDUSTRIAL: <br /> RESIDENCE: @ R/W <br /> PAVED FRONTAGE <br /> LENGTH: Ft X WIDTH: <br /> The ndersigned hereby ap lies for permission to excavate, truct and/or otherwise encroach on <br /> side of County HighwayRight-of-Way Ft. <br /> ��� <br /> of e � approximately ��®� g Wayyoo-n the <br /> by installing rfe`ep�mile- <br /> commence on orabout - <br /> for approximafely - <br /> SKETCH(Separate sheet ma e days. Work will <br /> fill this project be self-installed? YES <br /> _._NO Contractor's License - <br /> ENTRALSERVICES\CLERICALIPU6-SV.WKWASTaP&ENCR0ACHMEMPERMITORIVEWAY.DOC (09113) <br /> Page 1 of 2 <br />