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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVIEI.JfRON1AGIES . <br />.PERI\IlIT APPLICATION <br />Date:7 -/2.-1& <br />ReceivedBy:.T( <br />'CR#:--------- <br />SITEINFORMATION: <br />'areel Owner's Name:C y\.e..- <br />3iteAddress: <br />;i ,State,Zi Code: <br />,rea Code ..Tele hone Number: <br />'ame:l -Et'-idl <br />ddress: <br />i ,State,Zip Code: <br />rea Code -Telephone Number: <br />OFFICE USE ONLY <br />JOB#:11005 ISSUE DATE: <br />APN I/I-1-11'07 FEE DUE: <br />i::XP.DATE:[)DRIVEWAYS:STREET:d:ty 2zHf *V . <br />AREA:QUAD r(.*TYPE:,')!A/..-*FORMS:S>WW KI"7NOTES: <br />PRIVEWAY...... <br />TYPE:QUANtITY I WIDTHS <br />AGRICULTURE:I @FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL:I @RIW <br />RESIDENCE:1 <br />.PAVED FRONTAGE <br />lENGTH:Ft.X WIDTH:Ft. <br />The undersigned hereby applIesfor permission to excavate,construct and/or otherwise encroach on County Highway Ri9hf;~~.-yon theNsideofLVI)ol/c....-Dv approximateIy feetimlJe_ <br />Of--l>etl/'1!r AIlE','.,byInstalJing.. <br />.:~'. <br />___________________________________WorkwiI! <br />commence on orabout for approximately days. <br />SKETCH (Separate sheet may be submitted) <br />'. <br />JoiicA <br />Nr <br />'iI/this project be self-installed?YES NO Contractor's Ucense ---------------- <br />:ENTRAlSERVICES\ClER1CAl.\PUa.SV.WKIMASTER.PS\8llCROACHMENT PERMIT DRIVEWAY.DOC (09/13)Page10fl