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t <br /> COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#: <br /> SSu Plek, APPLICANT - OFFICE USE ONLY <br /> Name: <br /> Address: JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: 1C,1 j �7�-nr C,i s C 0Ca APN as7s FEE DUE: <br /> Area Code -Telephone Number. Ldk EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: QUAD <br /> Parcel Owner's Name: > ° QT a-Y�.°jV, M, giTYPE: - <br /> , Site Address: \Awq FORMS: S 1VzV / <br /> -City,State,Zip Code: t�-XUn CA NOTES: <br /> Area Code -Telephone Number:' <br /> DRIVEWAY. <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: a .A• u\ rz AGRICULTURE: @FRONTAGE <br /> Address: 93 5 J q COMMERCIAL: <br /> -City,State,Zip Code: 1� 42t U INDUSTRIAL: 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 H' ay Right-of-Way on the <br /> side of �G ' <' t`�RyT approximately �f fe ' _ 5i , <br /> Of LcJ3 ,by installing �icJGLiJJ}/ <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 /> U-.\CENTRALSERVICESICLERICALIPUB-SV.WMMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />