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COUNTY OF SAN JOAQUIN Date: � - <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: T ( <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 53�q ql5 3�,o <br /> APPLICANT OFFICE USE ONLY <br /> Name: V1 0 � _ -tti <br /> Address: lr JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code:- ,/} z —3 to APN <br /> /d!-oGo-/p FEE DUE: <br /> Area Code -Telephone Number: ej- e -1(" 4/- EXP.DATE: DRIVEWAYS: <br /> STREET: A�,qvxt'„/pwe <br /> SITE INFORMATION: AREA: 5r3 ck7ZA/ QUAD <br /> Parcel Owner's Name: TYPE: <br /> Site Address: 61 t v ik%/A L o N '-D;L FORMS: <br /> .City,State,Zi Code: .r�--t L A NOTES: <br /> Area Code -Telephone Number: -6 -1 <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: v - fit - 0 NT V--CLFvYI AGRICULTURE: (a)FRONTAGE <br /> Address: ( COMMERCIAL: <br /> City,State,Zip Code: L_j - ; r,!!- INDUSTRIAL: @ RMI <br /> Area Code -Telephone Number: RESIDENCE: Z <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permis ion to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> side of_ V,17 approximately feet/mile <br /> of by installing <br /> commence on or about for approximately days. Work will <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License <br /> M.kCENTRALSERVICESICLEP.ICALIPUB-SV.WKIMASTER.PSkENCROACHMEPIT PERMIT DRIVEWAY.DOC (09113} Page 1 of 2 <br />