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COUNTY OF SAN JOAQUIN Date: 4 <br /> DEPARTMENT OF PULI'C WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERWT APPLICATION CR#: 0340? <br /> APPLICANT OFFICE USE ONLY <br /> Name: Q lmseo <br /> Address: . 3 ,,o JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code:'!5;*" 1g1 5: APN �"'�-�t�p- �7 FEE DUE: law <br /> Area Code -Tele hwe Number: S"ZEXP.DATE: DRIVEWAYS: <br /> STREET: iyc <br /> SITE INFORMATION: AREA: QUAD <br /> Parcel Owner's Name: TYPE: <br /> Site Address: 11,75r'4 otl. l +Y' ; FORMS: <br /> Ci State,Z' Code: t NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH:. Ft. X WIDTH: Ft. <br /> The igned hereby applies f per iss to excavate, ns#uet and/or otherwise encroach on County H' bray Right-af-W on the <br /> side f J eOA, . approximately <br /> of ATAtese _by installing <br /> Work will <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 /> Y\FORMS&TEMPIATMENCROACHMENT PERMIT DRWEWAY.doc fWM) <br />