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I. <br /> 4/'i ( '� COUNTY OF SAN JOAQUIN Date: < -� <br /> / S <br /> DEPAR I HENT OF PUNIC WORKS . <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION R#: <br /> APPLICANT OFFICE USE ONLY <br /> Name: v evzc-& <br /> Address: Ox LS G JOB 4. 11005 ISSUE DATE: <br /> City,State,Zip Code: <j f'3 APNOq 0477 FEE DUE: <br /> Area Code -Tele hone Number: '21& EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: 110,pic-4 QUAD <br /> ParcelOwner'SName: 5'4c/e fiFl6c 1 4009TYPE: .J <br /> Site Address: Z t,4 s-'t:,_ _Rey FORMS: <br /> City, State,Zi Code: '9_r) L. G NOTES: <br /> Area Code -Telephone Number. 2 -ST S'i3 y <br /> DRIVEWAY. <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> - ( �, CXAGRICULTURE: @FRONTAGE <br /> Address: - V_ <br /> City, State,Zip Code: c.p w e-4 INDUSTRIAL: @ RNV <br /> Area Code -Telephone Number: 2 -3 Y -Z 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 County Highway Right-of-Way on the <br /> Fps T side of approximately feet/mile <br /> of by installing <br /> E-V G/L4>4 C,4 rh l,4' 'Pv, -b pe'i e-z Zv i. s p��� �-�l�✓ <br /> Work will <br /> commence on or about- for approximately / tij c-tT'/< days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License <br /> M:',CENTRALSERVICESICLERICALIPUB-SV.VvK1MASTER.PSIENCRO:ICHM�ENTPERMITORIVEVJAY.UOC (09113) Page Iof2 <br />