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COUNTY OF SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: <br /> APPLICANT OFFICE USE ONLY <br /> "AreaCode <br /> S -Iq11005 ISSUE DATE: <br /> JOB# <br /> ode: APN FEE DUE: <br /> e hone Number: EXP.DATE: DRIVEWAYS: <br /> STREET: <br /> SIT INFORMAT N: AREA: •� QUAD �js __ <br /> Parcel Owner's Name: ! B/1 cr' TYPE: Z✓ <br /> Site Address: b FORMS: ww <br /> -- <br /> City,State,Zip Code: NOTES: <br /> Area Code -Telephone Number.2o 7 d <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: FRONTAGE <br /> Address: COMMERCIAL: <br /> ff <br /> city, dip Code: INDUSTRIAL: I I SyR1W <br /> Area Code -Telephone Number: RESIDENCE: >1 <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 =1�6o <br /> on the <br /> side of approximately SZ' feet/mile <br /> of l `a 1 S �'7l by installing —ZaJ. <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 /> MICENTRALSERVICESC-LERICAL�PUMV.WK%%STER.PSIENCROACHNENTPERMR DRNEWAY.DOC (1=9) Pap 1°f 2 <br />