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COUNTY OF SAN JOAQUIN Date: o o � _ <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: -se— <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 038 <br /> _ APPLICANT OFFICE USE ONLY <br /> Name: C� -+- S S aG;A!TG�,- - <br /> Address: //(, rJ PL6kS A-./ JOB#: 11005 ISSUE DATE: <br /> City,State,Zi Code: � _ APN 457/— -t'12 FEE DUE: <br /> Area Code -Tele one Number: a -)3 EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> AA- <br /> SITE INFORMATION: AREA: rj QUAD %.* <br /> Parcel Owner's Name: TYPE: <br /> Site Address: L,*IlklE jep. FORMS: <br /> City, State,Zip Code: 10 NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> Ci ,State,Zip Code: INDUSTRIAL: @ RNV <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 Hi _way Right-of-Way on the <br /> E�4+si side of approximately 51AO > <br /> of A0&14d27 Qp by installing <br /> commence on or about for approximately days. Work will <br /> SKETCH(Separate sheet may be submitted) <br /> L <br /> Will this proiect be self-installed? YES NO Contractor's License <br /> Y'-FORMS A TEMPLA'ES ENCPOACHMENT PERMIT DRIVENAY.doc PA'm <br />