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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By:.f —Gj��--- <br /> DRIVEWAYS AND PANED FRONTAGES <br /> PERMIT APPLICATION �CR#: �`�' �(�'`j" �4 1 L � <br /> APPLICANT OFFICE USE ONLY <br /> Name: 17c. L+ A <br /> Address: 22-7 �-A JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: A 8- 9 r-;• 2 v APN 3 )��� L t FEE DUE: <br /> Area Code -Tele hone Number.2.' 53 ' dS j .. EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: ; QU D G, j - <br /> Parcel Owner's Name: `V e ,,/I e TYPE: <br /> Site Address: (rat Vv. lid d , �� FORMS: In 3 G <br /> City,State,Zip Code: - .Z p NOTES: <br /> Area Code -Telephone Number: �� ( c.,14,7— 01-b 3-- <br /> DRIVEWAY. <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: -f--:, PS,, t d AGRICULTURE: @FRONTAGE <br /> Address: t r�?t . w `V �i e COMMERCIAL: <br /> City,State,Zip Code: 6 ��,r, ti ��� c 9,5 INDUSTRIAL: @ RIW <br /> Area Code -Telephone Number: o;, o c3 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 Highway Right-of-Way on the <br /> side of 'isx. approximately 1JrY�1 feet/mile <br /> of \ 4 s ,by installing <br /> - <br /> commence on or about for approximately days. Work will <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's Licenseo cD — <br /> M:ICEWRALSERVICESICLERICALIPUB-SV.WI(\MASTER.PMENCROACHMENTPERMIT DRIVEWAY.DOC (09113) Page Iof2 <br />