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COUNTY OF SAN JOAQUIN Date: ( l S <br /> DEPARTMENT Of:PULIC WCRKS <br /> Received By: T <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> AP LICANT OFFICE USE ONLY <br /> Name: 1-01110 <br /> Address: _0 q- J r� . ' � 1� JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Cade: S GG L 0477 APN .1--75 240 0 ( FEE DUE: <br /> Area Code -Telephone Number} 2 OWEXP.DATE: DRIVEWAYS: <br /> STREET: L <br /> SITE INFORMATION: AREA: o QUAD �S - <br /> Parcel Owner's Name: TYPE:Site Address: FORMS: VI/ <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Num4er. <br /> DRIVEWAY. <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> .City,State,Zip Code: INDUSTRIAL: @ RIW <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 encroach on County Highway Right-of-Way on the <br /> side of /�C-6 G approximately feet/mile S" <br /> of C by installing <br /> Work will <br /> commence on or about for appro)imai`ely days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License <br /> NLICE4UnSERVICES\CLERICAL\PU&SV.VMMASTER.PS1ENCROACHMENTPERMITDRNMAY.DOC {091121 Pasotd9 <br />