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t <br /> COUNTY OF SAN JOAQUIN Date: 7 S <br /> DEPARTMENT OF PULIC WORKS �--/ <br /> Received By' <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 5,4 2,5� <br /> APPLICANT OFFICE USE ONLY <br /> Name:,JoSc C`�sill�i5 <br /> Address: C (,o JGB#: _ 11005 ISSUE DATE: <br /> City,State,Zip Code: 05 C«l DY) C"iy APN Q C13 FEE DUE: <br /> Area Code -Telephone Number: meq" ,S- EXP.DATE: 7- j DRIVEWAYS: <br /> STREET: S�/CZ4 g,� <br /> SITE INFORMATION: AREA: L- c l QUAD S C <br /> Parcel Owner's Name:,f 6SL 'ISi ffl�s �r11/��� �c�sillu' TYPE: _� - <br /> Site Address: �D (v 5r L�l!]e� FORMS: ' 6', ' <br /> -ity,State,Zip Code: ES(,, (;,1 I. LA- 2S 3 2-D NOTES: <br /> area Code -Telephone Number.(geei)SyS zl 1-77-7'e7 <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> game: AGRICULTURE:: @FRONTAGE <br /> kddress: COMMERCIAL: <br /> ;ify,State,Zip Code: INDUSTRIAL: @ R/W <br /> I,rea 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 Hjg)away Right of-Way on the <br /> side of 5 ;/��Phi approximately_ fee mile _ <br /> of �� ,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 /> A:ICENTRALSERViCES1CLERICALWUB.SV.VJK%MASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />