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COUNTY OF SAN JOAQUIN Date: j <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#:O U�S'GCo <br /> APPLICANT OFFICE USE ONLY <br /> Name-.- 7-/)V1 e I I u•1 <br /> Address: Po f3o x -Lc JOB#: 11005 ISSUE DATE: <br /> Ci ,State,Zip Code: -, ( C rl 9 S 3 G k APN ©�'�(-���_9 4 FEE DUE: <br /> Area Code -Telephone Number. -o, - zi �1 ?-0 3 EXP.DATE: DRIVEWAYS: <br /> STREET: Mo e SE . <br /> SITE INFORMATION: AREA: Lot)t QUAD <br /> Parcel Owner's Name: Et ,y-,-L (0 TYPE: n <br /> Site Address: 5-67- e FORMS: <br /> City,State,Zip Code: r 7A- qS_z y o NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> e: 7 b"4v, - i t-��� AGRICULTURE: FRONTAGE <br /> Nam <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ RM <br /> Area Code -Telephone Number: RESIDENCE: r <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission o Qxcavate,construct and/or otherwise encroach on County Highwa Right-of-Way on the <br /> side of approximately L fee it -- <br /> of_ =�L ��•` - C?ClL by installing <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? L/ YES NO Contractor's License <br /> 1\SJPWGOV.ORGISHARESICENTRALSERVICEMCLERICALIPU&SV.WK\MASTER.PSVENCROACHMENT PERMIT DRNEWAY.DOC (10109) Page 1 of 2 <br />