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COUNTY OF SAN JOAQUIN <br />DEPARTMENT OFPULIC NlORKS <br />DRIVEWA'YS,AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />APPLICANT _ <br />Name: <br />Address <br />City, State <br />Area Code -Telephone Number. "Z 5� _ tS g I - 53 <br />SITE INFORMATION: <br />Parcel Owner's Name <br />Site Address: 2'a da1 <br />City, State, Zip Code: <br />Area Code -Tele hone Number: <br />CONTRACTOR <br />Name: <br />Address: A_ <br />City, State, Zip Code: 9 <br />Area Code - Telephone Number: <br />Date: . j214 1-7 —_ <br />Received By: <br />C3#:,9J`' <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right -of -Way on the <br />side of �j 6-�-,n x? _ _approximately i % 9 fee ile C� j <br />of Ka- ,_ ,by installing <br />commence on or <br />sheet may be <br />Will this project be self -installed? YES NO <br />WNMANMEM WM .,F-Tli pl.MRDACBMENT PERMR ORIVEWAYAtt(WH) <br />approximately <br />Contractor's License <br />days. <br />Work will <br />OFFICE USE ONLY <br />JOB M <br />11005 ISSUE DATE: <br />APN <br />_ <br />f;I^ D FEE DUE: <br />EXP. DATE: <br />DRIVEWAYS: <br />STREET: <br />`_N/ltLt®a�1 12[x, <br />AREA: <br />�B ,tis D� tJ QUAD ►�t� -- <br />TYPE: <br />pQ,f UE w3Q y�Q <br />FORMS: <br />NOTES: <br />-- <br />DRIVEWAY <br />TYPE: <br />QUANTITY_ <br />WIDTHS <br />AGRICULTURE: <br />FRONTAGE <br />COMMERCIAL: <br />_ <br />INDUSTMAL: <br />_ <br />0 RNV <br />RESIDENCE: <br />_ <br />PAVED FRONTAGE <br />LENGTH: <br />Ft. X WIDTH: Ft. <br />The undersigned hereby applies for permission to excavate, construct and/or otherwise encroach on County Highwa Right -of -Way on the <br />side of �j 6-�-,n x? _ _approximately i % 9 fee ile C� j <br />of Ka- ,_ ,by installing <br />commence on or <br />sheet may be <br />Will this project be self -installed? YES NO <br />WNMANMEM WM .,F-Tli pl.MRDACBMENT PERMR ORIVEWAYAtt(WH) <br />approximately <br />Contractor's License <br />days. <br />Work will <br />