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67 ol 5, , <br /> COUNTY OF SAN JOAQUIN Date: .7 <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 3 <br /> 5 r <br /> 50 ( �75, <br /> APPLICANT OFFICE USE ONLY <br /> Address:,i'r- /S C? , ;q r ,��y JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: Sy-A5 �, �z/�- APN 0 5S7j -4 FEE DUE: <br /> Area Code -Telephone Number. /5�z, EXP.DATE: DRIVEWAYS: <br /> STREET: r�lCt1/y �I�-lJ-�l <br /> SITE INFORMATION: AREA: S /t Iil QUAD - <br /> Parcel Owner's Name:-,S-oy UJ ,1�G� y,�iklL D, TYPE: SQA <br /> Site Address:�3� -sem P, �� FORMS: <br /> State,Zip Codesf,,5y 1-5- NOTES: <br /> Area Code -Telephone Number:, V ,,ab Z) <br /> DRIVEWAY, <br /> CONTRACTOR • TYPE: QUANTITY WIDTHS <br /> Vame: iJ r AGRICULTURE: @FRONTAGE <br /> address: P, a e K---.? COMMERCIAL: <br /> 'ity,State,Zip Code:��G �h s INDUSTRIAL: @ RIVU <br /> krea Code -Telephone Number. ^3_? <br /> RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies f r permissii n to exc Vafe,construct and/or otherwise encroach County Hi h y Right-qf-Way on the <br /> side of 5 0 Pq(/I KQ yI( approximately J. <br /> Of by installing <br /> commence on or aboutfor Work will <br /> approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Vill this project be self-installed? YES /1" NO Contractor's License <br /> ICENTRALSERVICESICLERICALTUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Page A 1 of 2 <br />