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COUNTY OF SAN JOAQUIN Date: ✓� oho�p/D <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVMY'S AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 61�j <br /> APPLICANT OFFICE USE ONLY <br /> Name: <br /> �J Address' to JOB# 11005 ISSUE DATE: <br /> ^ <br /> City,Ste,I Zip Code le.APN Z 4 FEE DUE: <br /> Area Code -Telephone Number:10-' 3, -d Yah EXP.DATE: DRIVEWAYS: <br /> STREET: 6wA4y&1 <br /> SITE INFORMATION: AREA: , 1,#hfZW QUAD N_,-- <br /> Parcel <br /> EParcel Owner's Name: e TYPE: <br /> X Site Address: 17 7 9 - j% &_ FORMS: <br /> Ci ,State,Zip Cede: G S d NOTES: <br /> Area Code -Telephone Number: :Z —62 M <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Names , #s AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Z.( Code 1 INDUSTRIAL: RM! <br /> Area Code -Telephone Number: -3 RESIDENCE: Ali <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The under igned hereby applwes for permission to exoavate,construct and/or otherwise encroach on unty Hi hway Right-of-0)a on the <br /> csf c_„ approximately <br /> of E) by installing <br /> G i y 42 41 C400_409 C4-1,0C.Cf bgse gLy cm, IL-d <br /> or <br /> e a- tik <br /> Work will <br /> commence on or about for approximately .o3 days. <br /> SKETCH(Separate sheet may be submitted) <br /> Ab <br /> F n <br /> A <br /> 1 it <br /> � s <br /> 3r 4 P <br /> K � <br /> 1 <br /> 1 <br /> all- <br /> 1 � <br /> Will this project be self-installed? YES _ NO Contractor's License 32,6.3 q <br /> btkCENTRALSERVICES\CLEPoCALIPUMV.WKIMASTERPSIENCROACHMENT PERWT DRIVEWAY.DOC (10)09) Page 1 of 2 <br />