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PS -2103177 <br />COUNTY OF SAN JOAQUIN <br />DEPARTMENT OF PULIC WORKS <br />DRIVEWAYS AND PAVED FRONTAGES <br />PERMIT APPLICATION <br />Date: OI 10 . <br />Received By:11� <br />CR#: R0 13337 <br />APPLICANT <br />Name: Ar <br />L0 <br />Address: <br />, <br />City, State, Zi Code: <br />Area Code - Tele hone <br />Number: o <br />Email: ' <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />SITE INFORMATION: <br />Parcel <br />Owner's Name: <br />INDUSTRIAL: <br />Site Address: <br />@ R/W <br />RESIDENCE: <br />City, State, Zip Code: <br />C1 S$ <br />Area Code -Telephone <br />Number: <br />LENGTH: <br />CONTRACTOR <br />Name: <br />Address: <br />City, State, Zip Code: <br />Area Code -Telephone <br />Number: <br />Date: OI 10 . <br />Received By:11� <br />CR#: R0 13337 <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the <br />Eag} side Rd of approximately I;aL, ale Wile Sou} <br />Cl� <br />of a,.11 la � ,by installing <br />commence on or about <br />for approximately <br />SKETCH (Separate sheet may be submitted) <br />Lo'tr4Ca� �2 <br />-- --pro <br />�" <br />Will this project be self -installed? YES NO <br />%'fNpiOPCHMEMSVAesla FartaiwrylalrelENCROACHAENr PERM1IpWEWRYtloo�OBNO) <br />Contractor's License <br />Work will <br />OFFICE USE ONLY <br />JOB #: <br />APIN <br />EXP, DATE: <br />STREET: 1a4 <br />AREA: M� <br />11005 ISSUE DATE: <br />D-10 FEE DUE: <br />DRIVEWAYS: <br />A�o <br />e�q AD <br />TYPE: <br />FORMS: <br />NOTES: <br />DRIVEWAY <br />TYPE: <br />QUANTITY <br />WIDTHS <br />AGRICULTURE: <br />I @FRONTAGE <br />COMMERCIAL: <br />INDUSTRIAL: <br />@ R/W <br />RESIDENCE: <br />/ <br />PAVED FRONTAGE <br />LENGTH: <br />Ft, X WIDTH: Ft. <br />The undersigned hereby applies for permission to excavate, construct andlor otherwise encroach on County Highway Right -of -Way on the <br />Eag} side Rd of approximately I;aL, ale Wile Sou} <br />Cl� <br />of a,.11 la � ,by installing <br />commence on or about <br />for approximately <br />SKETCH (Separate sheet may be submitted) <br />Lo'tr4Ca� �2 <br />-- --pro <br />�" <br />Will this project be self -installed? YES NO <br />%'fNpiOPCHMEMSVAesla FartaiwrylalrelENCROACHAENr PERM1IpWEWRYtloo�OBNO) <br />Contractor's License <br />Work will <br />