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r'()l 1 ITv nF=Cull 1(l�rll IIN Date' <br /> DEPARTMENT OF PULIC WORKS <br /> Received By: 5i <br /> DRIVEWAYS AND PAVED FRONTAGES <br /> PERMIT APPLICATION CR#: 03'?/9 3 <br /> PLICANT OFFICE USE ONLY <br /> Name: <br /> Address: JOB#: 11005 ISSUE DATE: <br /> City,State,Zip Code: N G° APN /d1 - FEE DUE: <br /> Area Code -Telephone Number: ,-01 EXP:DATE: DRIVEWAYS: <br /> STREET: A I <br /> SITE INFORMAT ON: AREA: zjly. _,s, yatWOUAD <br /> Parcel Owner's Name: TYPE:47- T� <br /> Site Address: O FORMS: AZZ <br /> city,State,Zi Code: `CL)ev NOTES: <br /> Area Code -Telephone Number <br /> DRIVEWAY <br /> CONTRACTOR TYPE: QUANTITY WIDTHS <br /> Name: AGRICULTURE: Q FRONTAGE <br /> Address: COMMERCIAL: <br /> City,State;Zip Code: INDUSTRIAL: @ R/W <br /> Area Code -Telephone Number: RESIDENCE: Xi <br /> PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on the <br /> side of approximately feet/mile <br /> of by installing <br /> Work will <br /> commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> I <br /> I <br /> I <br /> i <br /> Will this project be self-installed? YES NO Contractor's License <br /> Y'FOFMS d TEMPtATMENCROACMMENT PENT DFdYEWAY.d=;,oawj <br />