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COUNTY OF SAN JOAQUIN Date: Z~2 <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 031Z f _ <br /> - o .�t� <br /> APPLICANT OFFICE USE ONLY S qb 16 <br /> i Name: F_vwia 0 <br /> Address: 244*d ,oj , 3 k R.s JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: /00 e.4 95'Z z._a APN Ckj 7— :3 2( FEE DUE: <br /> Area Code -Telephone Number: EXP.DATE: DRIVEWAYS: <br /> !?4A STREET: ` ,mak 9;M., <br /> SITE INFORMATION: AREA: AcArvtft.? QUAD mE <br /> Parcel Owner's me: !&z 2rN TYPE: <br /> Site Address: z f-q-to , �34,:je P-13FORMS: /7 <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number:'A - _ a,5-2'0:1 EE <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 undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> side of approximately feettmile <br /> of by installing <br /> Work will <br /> commence on or about_ for approximately days. <br /> SKETCH(Separate sheet may be submitted) l` <br /> 03 <br /> I; <br /> Will this protect be self-installed? YES NO Contractor's License a� <br /> v'FORMS 3 TPM?I.ATFS'FNCROACHMENJT PERMIT DRIVE WA V,7M!GV)81 <br />