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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PUL1C WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received By: <br /> PERMIT APPLICATION CR#: 1590 -7-1 _ <br /> APPLICANT OFFICE USE ONLY <br /> Name: 1 , <br /> Address: JOB#: 11005 ISSUE DATE: <br /> -City,State,Zip Code: i Ak. APN -b5?--S 2r'',--69 FEE DUE: <br /> Area Code -Tele hon Number: ? A EXP:DATE: DRIVEWAYS: <br /> STREET: aGo't T`. l,4 L S K 0. <br /> SITE INFORMATION: AREA: QUAD <br /> Parcel Owner's Name: TYPE: C—),- <br /> Site Address: ., FORMS: S <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: TAGE <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 herebyapplies for permission to excavate,construct and/or otherwise encroach on County Hi way Right-of-Way on the <br /> ✓ side of Sc.rsrs2bgl.491- approximately 1700 <br /> Of 1661 Y by installing _ ?,�j,/ <br /> Work wil <br /> commence on or about _ for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? YES NO Contractor's License <br /> YIFORMS&TEMPIATESENCROACHMENT PERMIT ORIVEWAY.d.(Oaft) <br />