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Date:'z-1).,-I6 <br />Received By:'-I_C _ <br />CR#'~>9 8:.<1-P5-Ib()OGSr <br />OFFICE USE ONLY <br />JOB#:11005 ISSUE DATE:APN 2.::?Jl.OGO./7 FEE DUE:EXP.DATE:DRIVEWAYS:STREET:H R.~'11 ~•AREA:'".I.QUAD St-•TYPE:r\/L/•FORMS:,,~1'{17NOTES: <br />DRIVEWAY, <br />'JYPE:QUANtiTY I WIDTHSAGRICULTURE:/t @FRONTAGECOMMERCIAL:V <br />INDUSTRIAL:I @RIWRESIDENCE: <br />,PAVED FRONTAGE <br />lENGTH:Ft.X WIDTH:Ft. <br />,,COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRiVEWAYS AND PAVED fRONTAGES' <br />,PERMIT APPLICATION <br />APPlicANT <br />CONTRACTOR <br />,' <br />The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the_____slde of approximately feetlmile _ <br />of •by installing _ <br />commence on orabout for approximately days.-----------------------Workwill <br />SKETCH (Separate sheet may be submitted) <br />IIthis project be self-installed?YES NO Contractor's License _ <br />NTRAlSERVJCES\CLERICAL\PUS-SV.WK\MASTER.PS\ENCROACHMENT PERMIT DRNEWAY.DOC (09113)Page 1of2