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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> PA n �!� All Received By: j <br /> `�bC� � Lj� <br /> r�_�� RI�fEl 6AYS AND PAVED PERMIT APPLICATION TACE`� CR#: S4 ¢d 6 <br /> APPLICANT OFFICE USE ONLY <br /> Name: U aV\ <br /> Address: VS--a Qp 'C'"'rr4 u JOB#: 71005 ISSUE DATE: <br /> City,State,Zip Code: 'e C ,,�. APN Q49 7 3O 15 FEE DUE: <br /> Area Code -Telephone Number. EXP.DATE: DRIVEWAYS: <br /> STREET: t U rr V <br /> mud, <br /> SITE INFORMATION: AREA: QUAD 41C <br /> Parcel Owner's Name: M y TYPE: /} <br /> Site Address: r-4 FORMS: <br /> -City,State,Zip Code: k' NOTES: <br /> Area Code -Telephone umber. ap Q L{ <br /> DRIVEWAY, <br /> _ CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ R/W <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 endo op County Highway Right-of-Way on the <br /> side of vt j^Y l/ approximately feet/mile 41_ <br /> of �A—�� �,� ,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:ICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENTPERMIT DRIVEWAY.DOC (09113) Page Iof2 <br />