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�'.3-cs4o!s'61 <br /> COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: !&`r-�''" <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: b3� _ <br /> APPLICANT OFFICE USE ONLY <br /> Name: t� q— 5 2-q--1 <br /> Address: t 4j'7 4 JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: C A APN 165'- l FEE DUE: <br /> Area Code -•Tele hone Number: 2cz`1 Y$3 5-??o EXP.DATE: DRIVEWAYS. <br /> STREET: hC.G.�r. <br /> SITE INFORMATION: AREA: huh QUAD Al <br /> Parcel Owner's Name: : z- 8 V- TYPE: V't _ <br /> Site Address: l 'V ��cA#_3 c FORMS: 5 wu). --City,State,Zip Code: L: •J e A NOTES: <br /> Area Code -Telephone Number: Copt +-196 STI <br /> I <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: i- XL C wN N"k e"'r-s F AGRICULTURE: @FRONTAGE <br /> Address: X S 60 rt5, n c COMMERCIAL: <br /> City,State,Zip Code: CA• S L INDUSTRIAL: R/W <br /> Area Cade -Tele hone Number: X39 1 tpa RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X MOTH: Ft. <br /> The undersigned hereby applie r permission tg,ecavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> 7i side of approximately 26 fggt/rr►Ile <br /> of_ ,Qa,., �..1�. by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Q L-i A-U( <br /> c� <br /> nn� <br /> Will this project be self-installed? YES NO Contractor's License <br /> Y\FORMS 8 TEMPLATMENCROACHWNT PERMIT ORIVEWAY.doa IOnS8 <br />