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COUNTY OF SAN JOAQUIN Date: q- t-2ccJ <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: OW G,? <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#:L3rt4 9 3 f5—fib[ <br /> APPLICANT OFFICE USE ONLY <br /> Name: rr <br /> Address: 3 5` - JOB#: 11005 ISSUE DATE: <br /> City,State,ZI Code: 4=A APN Zq -V 6b -d4 FEE DUE: <br /> Area Code -T hone Number ... jr/ EXP.DATE: —� DRIVEWAYS: <br /> STREET: YfaSe-yv%--t = Avie, <br /> SITE INFORMATION: AREA: L.c�)&we QUAD S E„ <br /> Parcel Owners Name: TYPE: <br /> Site Address: FORMS: W ► <br /> City, te,Zip Code: NOTES: <br /> Area Code -Telephone Neer: 2 a 143s,k <br /> - <br /> 1 C eky 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: I <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> side of 4, approximately feet/RK <br /> of v5 ,by installing 2 "t}.sTl�i�sc..�Z` 'Oveti <br /> 54e.d <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 IFORMB d TEMPLATESEN0 0ACHK ENT PEPMT DRNEWAY.dx(MM <br />