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COUNTY OF SAN JOAQUIN Date: - ( ¢ <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES S 73 <br /> PERMIT APPLICATION CR#: <br /> P. - i50 - <br /> APPLICANT OFFICE USE ONLY <br /> Name: r' L <br /> Address: JOB#. 11005 ISSUE DATE: <br /> City,State,Zip Code: � APN ( FEE DUE: <br /> Area Code -TelephoneNumber. EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: � QUAD - <br /> Parcel Owner's Name: V,56z;/l, !S TYPE: Z` - <br /> SiteAddress: FORMS: 51 FA Q <br /> Ci ,State,Zi Code: _S- L� NOTES: <br /> Area Code -.Telephone Number: ° 33 <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: . , [ AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: <Ile C;� INDUSTRIAL: @ RM <br /> Area Code -Telephone Number: >� Z.S S 2 RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise enQrpqq4 on County Higf ay Right-of-way on the <br /> side of 614 0 4-P U approximately l fee mile <br /> of 1/' ,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.,%CE4TRALSERVICESICLERICALIPU6-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />