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COUNTY OF SAN JOAQUIN Date; <br /> �► � DEPARTMENT OF PULIC WORKS <br /> �- Received By. <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> OY• PERMIT APPLICATION CR#: -,3 / 5 <br /> APPLICANT . OFFICE USE ONLY <br /> Name: Tol,? �. Ie, <br /> Address: 013 e yi�ci�� �> ti ��. JOB#. 11005 ISSUE DATE: <br /> City,State,Zip Code: APN FEE DUE: <br /> Area Code -Telephone Number: 00,1- EXP.DATE: 7-30 -It/, DRIVEWAYS: <br /> STREET: Ab�ITQ�ck <br /> SITE INFORMATION- AREA: �y) QUAD S, <br /> T/,,, <br /> Parcel Owner's Name: /�K %u lti � 7;.-?,•f TYPE: a <br /> Site Address: 2175/ FORMS: SS WW t <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number. �U�i-�lc��z6GC3 <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: I @FRONTAGE <br /> Address: ✓'. COMMERCIAL: <br /> City,State,Zip Code: 153-,� lY, C- , 9 3?v INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number. 2O%-4T0-Z4GO 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�unty Highway Right-of-Way on the <br /> ilf -� ' side of i�e�i�os� approximately. 2-�6_#ee }e G <br /> of ow 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:\CENTRALSERVICES\CLERICAL\PUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page 1 of 2 <br />