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UUUN I Y U1= SAN JOAQUIN Date: <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES _ <br /> PERMIT APPLICATION CR#: zW720, S <br /> APPLICANT OFFICE USE ONLY <br /> Name: s 6, <br /> Address: ,o 7 I D 2 vkf MEA C� &�J; JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: r= L ►ZG v z APN FEE DUE: <br /> Area Code -Telephone Number: q 6; y S e�,' EXP. DATE: DRIVEWAYS: <br /> STREET: <br /> ; . <br /> SITE INFORMATION: AREA: QUAD ^/ <br /> Parcel Owner's Name: 1)6 cjt�,,z_ra s (?,;,2 b TYPE: 1pt,J <br /> Site Address: Z& 3 7 zf nJ ji f\,-vv F 5 i L FORMS: <br /> City, State,Zip Code: (-n P ol C p, , NOTES: <br /> Area Code -Telephone Number: ci/4, 6 — <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: RESIDENCE: toW <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 Hiy Right-of-Way on the <br /> X"As ' side of approximately fe �.r�if <br /> of 5;0/6�SS k?a ,by installing 5c-0 <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 /> \\SJPWGOV.ORG\SHARES\CENTRALSERVICES\CLERICAL\PUB-SV.WK\MASTER.PS\ENCROACHMENT PERMIT DRIVEWAY.DOC (10109) Page 1 of 2 <br />