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((4 / / COUNTY OF SAN JOAQUIN Date: <br /> ( ( �� (� DEPARTMENT OF PULIC WORKS <br /> '-b Mee+ 'rer Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> ✓1S�'J 'Ec4w) PERMIT APPLICATION CR#: S �� <br /> APPLIQANT OFFICE USE ONLY <br /> Name: Kh - ?-k <br /> Address: v;-n i zN" JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: APN 201 L SO FEE DUE: <br /> Area Code -Telephone Number: amu/ 0e)y–"7f EXP.DATE: _DRIVEWAYS: <br /> STREET: 09 a, <br /> SITE INFORMATION: AREA: _� �J QUAD E - <br /> Parcel Owner's Name: -q f'—< TYPE: _ <br /> Site Address: t�/� ' ifaQ�� �e� t ,E'rj FORMS: SS l vw17 <br /> City,State,Zip Code: =s c'� %Q�; (a 5'" NOTES: <br /> Area Code -Telephone Number: 62 C;ca 41 - 7 <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RNV <br /> Area Code -Telephone Number: RESIDENCE: 14Z <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 Hi hway Right-of-Way on the <br /> ko � side of �oaL1s �, approximately -Z5-t;, a _ <br /> of_ ` A.,j Ai-LCAD Ra. Facg'\-s -Q by installing N-IvJ <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> A <br /> Will this project be self-installed? _ YES NO Contractor's License <br />