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COUNTY OF SAN JOAQUIN Date: ' - <br /> DEPARTMENT OF PULIC WORKS <br /> DRIVEWAYS AND PAVED FRONTAGES Received 8y: 5-ca9otgSZ <br /> PERMIT APPLICATION CR#: Z-- <br /> APPLICANT OFFICE USE ONLY <br /> Name: ✓li <br /> Address: 1 3 A Q JOB# 11005 ISSUE DATE: <br /> City,State,Zip Code: APN66.39- FEE DUE: <br /> Area Code -Telephone Numbpr EXP.DATE: DRIVEWAYS: <br /> A9C l �c' �r <br /> t STREET: .e.k - <br /> SITE INFORMATION: AREA: i � { Ap N E <br /> Parcel Owner's Name: ra. r TYPE: 01Ll <br /> Site Address: " IJA FORMS: 5S110V3�? --� <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number. <br /> CONTRACTOR DRIVEWAY <br /> TYPE: QUANTITY WIDTHS <br /> Name: <br /> Address: AGRICULTURE: FRONTAGE <br /> COMMERCIAL: <br /> City,State,ZipCode: INDUSTRIAL: y <br /> Area Code -Telephone Number. RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigped hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> � _side of ( approximately $g Cti t feet�mile <br /> Of �_f�1?�--b Act 1 a„� k ,4 by installing <br /> commence on or about for approximately days. Work will <br /> SKETCH(Separate sheet maybe submitted) <br /> i <br /> l <br /> i <br /> I <br /> I � <br /> i <br /> i <br /> I <br /> Will this project be self-installed? YES NO Contractors License <br /> M:ICENTRALSERVICESV:LERICALIPJESV.WKU/AST_R2.PSIBCROACHMENT PERMIT DRIVEWAY.DOC (01108;, Page 1 of 2 <br />