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.C~() <br />'2-0 CJ -7 Lt ]-S III g COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED ~RONTAGES ' <br />PERIVIITAPPLICA TIOI\I <br />(fj.-J~41tj,. <br />Date:J2.-l-I-Z::>/5 <br />Received By:~Z:- <br />APPliCANT <br />SITE INFORMATION: <br />Parcel Owner's Name: <br />Site Address: <br />Ci •State,Zi Code: <br />Area Code.Tele hone Number: <br />CONTRACTOR <br />Name: <br />Address: <br />City,Stafe,Zip Code: <br />4rea Code.Telephone Number. <br />OFFICE USEONLY <br />,JOB#:11005 ISSUEDATE:APN ,CX2'>-fu-~FEE DUE:EXP.DATE:~VEWAYS:STREET:~kReL',•AREA:•QUAD M")TYPE:J..kt\ld.."lO.'I .'•F6RMS:SYiI)I•.J t1'::1lNOTES:, <br />DRIVEWAY..,'TYPE:QUANTITY I WIDTHSAGRICULTURE:I @FRONTAGECOMMERCIAL:IINDUSTRIAL:I @RIWRESIDENCE:. <br />.'.PAVEDFRONTAGElENGTH:Ft.X WIDTH:Ft. <br />.:~'. <br />---------------------,,---------__,__--__Workwillcommenceonorabout,__---_for approximately days. <br />SKETCH (Separate sheet may be submitted) <br />Nill this prajectbe self-installed?+YES NO---Contracto~s License --------------- <br />:\CENTRAlSERVlCES\Cl..ERICAL\PUSSV.WK\MASTER.PSIENCROACHMENTPERMIT DRWEW.AY.DOC (09Il3)Page 1oI2