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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> �w Received By:� )�'� r <br /> RC1 cI Z' DRIVEWAYS AND PANED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> APPLICANT OFFICE USE ONLY <br /> Name: . b r 8t3cW 0-fl <br /> Address: ' (9( !✓ K �' Leyte-^ C� ' JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: l_()G CJS APN C63-pt(p FEE DUE: <br /> Area Code -Telephone Number. Cif bI - EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: QUAD 1 - <br /> Parcel Owner's Name: Y ut TYPE: L <br /> Site Address: IH to t2, ei�I vv -,-ti L1'1 FORMS: <br /> City,State,Zip Code: L,042k i C(N X153''_ NOTES: <br /> Area Code -Telephone Number- C) <br /> DRIVEWAY. <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: 2„ @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RNV <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby ap lies for permission to excavate,construct and/or otherwise encroach on County Hi hway Ri ht-of-Way on the <br /> ( U� side f 1 ,`� C_ .+�. _approximately140/)"3 �S 1 ee mile L <br /> of by ins ailing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> ill this project be self-installed? r— <br /> YES NO Contractor's License <br /> M:ICENTRALSERVICESICLERICALIPUB-SV.WKWASTER.PSIENCROACHMEIQT PERMIT DRIVEWAY.DOC (09113) Page i of 2 <br />