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• COUNTY OFSAN„OAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVE©FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> Name: 11005 ISSUE DATE: <br /> Address: JOS�: <br /> City,State,Zi Code: APN OWt—Afo� FEE DUE: <br /> Tele hone Number: EXP.DATE: DRIVEWAYS: <br /> Area Code - <br /> STREET: ;:k1--n�2 ?-!;tSITE INFORMATION: AREA: c,�tote' QUAD �clE <br /> Parcel Owner's Plaine: u TYPE: <br /> Site Address: FORMS: <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number: O <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: ' FRONTAGE <br /> Address: - COMMERCIAL: <br /> City,State;ZipCode: INDUSTRIAL: R/W <br /> Area Code -T hone 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 feet/mile <br /> of ,by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> I <br /> Will this project be self-installed? YES NO Contractor's License <br />