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COUNTY OF SAN JOAQUIN Date-, <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> APPLICANT 55 OFFICE USE ONLY <br /> Name: I ( .. /� <br /> Address: � '� Z �� •�1- JOB#: 11005 <br /> City,State,Zip Code: �,` �;� ( �1 c;3(, ISSUE DATE: <br /> APN A72-1210- <br /> Area -1'1 FEE DUE: <br /> Code -Tele hone Number: ZG��= ���/,Z3�1`�. EXP.DATE: <br /> DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: <br /> , , QUADParcel Owr`s Name: <br /> TYPE: <br /> Site Address: U S`` (,q5 FORMS:CState,Zip Code: f <br /> n S� <br /> NOTES: <br /> Area Code -Telephone Number: 2G�1— yg)—Z3tl <br /> DRIVEWAY, <br /> CONTRACTOR TYPE: QUANTITY <br /> Name: (/f s 5 f GY1 Slt i 1�Cu' <br /> in AGRICULTURE: WIDTHS <br /> Address: ,+7, @FRONTAGE <br /> City,State,Zip Code: d,� 41 <br /> COMMERCIAL: <br /> Area Code -Telephone Number: c1 _7 3 3�1 RESIDENCE:INDUSTRIAL: @ R1VU <br /> �� l <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 /> WEst' side of c wn-&— fkz, ��pQ roximately 6� <br /> by installingi ,.1ygf <br /> commence on or about for approximately Work will <br /> days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License <br /> PA:ICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENT PERMIT DRIVEWAY.DOC (09113) Pael 1 of 2 <br /> 9 <br />