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COUNTY OF SAN JOAQUIN Date: 2(�)l) <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: — <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#:a t4Y,26'(�, <br /> APPLICANT OFFICE USE ONLY <br /> Name: u:t <br /> Address: Po 13c,x sc 37 JOB#: 11005 ISSUE DATE: <br /> City,State,Zi Code: S, ,'d c�4 q S 3 6 APN ©�'�(-� ,� y FEE DUE: <br /> Area Code -Telephone Number: EXP.DATE: DRIVEWAYS: <br /> STREET: A0 <br /> SITE INFORMATION:, AREA: Lot)t QUAD <br /> Parcel Owner's Name: 5c4 Q,, fz, TYPE: v e <br /> Site Address: FORMS: <br /> City,State,Zip Code: rA qs-z y o NOTES: <br /> Area Code -Telephone Number: <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTUR @FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State,Zip Code: INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: RESIDENCE: <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission o xcavate,construct and/or otherwise encroach on County High a Ri ht-of-Way on the <br /> SQA side of w(7vs approximately f fee it - <br /> of k 1,.-):�,, 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? `� YES NO Contractor's License <br /> USJPWGOV.ORGISHARESICENTRALSERVICESICLERICALIPUB-SV.WKIMASTER.PSIENCROACHMENTPERMITDRNEWAY.DOC (10109) Page Iof2 <br />