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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> APPLICANT OFFICE USE ONLY <br /> Name: 1_>o, M - r u 11005 ISSUE DATE: <br /> Address: te,>qi E F- o,, s JOB#: <br /> City,State,Zip Code: �-;n ' - 3 � APN -Q FEE DUE: D �— <br /> � - � �- I(v I f3 EXP.DATE: DRIVEWAYS: <br /> Area Code -Telephone Number: <br /> STREET. ^—)—r S� <br /> SITE INFORMATION: AREA: QUAD ///� ' <br /> Parcel Owner's Name: Dc,;-, rn_ c,i e TYPE: <br /> Site Address: 0 & - F70 Q�J i l FORMS: yS L✓w -/� <br /> City, State,Zip Code: L-nct e pn C.a l ct NOTES: <br /> Area Code -Telephone Number: �)psi - ct9-d - I to 8 <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: <br /> AGRICULTURE: FRONTAGE <br /> Address: COMMERCIAL: <br /> City, State,Zip Code: <br /> INDUSTRIAL: Rll�/ <br /> Area Code -Telephone Number: RESIDENCE: x <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The uersigned hereby applie or permission to excavate,construct and/or otherwise encroac,9 County e ay Right-of-Wa on the <br /> d�V side of 1.�/�- ST, approximately <br /> by installing__fit✓ <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 /> M9CENTRALSERVICESICLERICAL\PUB-SV WK\MASTER PS\ENCROACHMENT PERMIT DRIVEWAY DOC (10109) Page 1 of 2 <br />