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/ 1 <br /> COUNTY OF SAN JOAOUiN Da?e; <br /> DEPARTMENT OF PULIC WORKS <br /> Received By. <br /> DRIVEWAYS AND PAVED FRONTAGES CR#. D39�59 <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> jName: "IS 3 ivJ1 2 J C_��V 'x' <br /> Address: ► 1-► JOB#: 11005 ISSUE DATE: <br /> City,State.Zip Code. L,)cl q C a 40 APN LYo3-/S"v-3(o FEE DUE <br /> Area Code Telephone Number. Q�,q - -7 4 �-��� 7C► EXP. DATE: DRIVEWAYS: <br /> STREET: <br /> SITE INFORMATION: AREA: D/ <br /> IParcel Owner's_Name: l(Yl(-'�a S TYPE: ?7L✓ --Site Address: FORMS: <br /> City, State,Zip Code: NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: <br /> AGRICULTURE: I I5FRONTAGE <br /> COMMERCIAL: <br /> Address: @ <br /> Cityt :Zip CodeINDUSTRIAL: <br /> - - <br /> — -- <br /> Area Code -Telephone Number RESIDENCE: PAVED FRONTAGE _ <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County y Right of Way on the <br /> F_� _side - - LOc u�`C THEE KKK, approximately 2 _—fee de 1�1 a <br /> of RtCi�\E`I Lh� by installing — ---- <br /> --- — -- - Work will <br /> --- ------ <br /> commence on or about for approximately -- - ay.- <br /> SKETCH (Separate sheet may be submitted) <br /> i <br /> Will this project be self-installed? _—YES NO Contractor's License <br /> M;OE'dTPAISEP',y CES .-6PCAL PU S'l '4KVPSiER.PS'P+CRCAC—ME NT PERMIT DRIVEWAY DOC :I C;019} zage1of2 <br />