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DEPARTMENT OF PUBLIC WORKS Received by- _ <br /> CR# 0 2aD�D, _ <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> J APPLIC OFFICE USE ONLY <br /> e 1-0 JOB#11005 ISSUE DATE / I <br /> (110C? �G N U ,� N � 00 - 13 FEE DUE <br /> RIVEWAYy�S-� <br /> AddressSTREET O6E&A&2f� Atm. <br /> P <br /> _ J n / �lg.✓�c.9 QUAD SE <br /> City2 State_-Zip Code TYPE <br /> ORTvIS 55 ww /7 <br /> (Area )Telephone OTE —�—' <br /> IldFO TION 1 <br /> Parcel Ownces Name ' <br /> 2 �L _ <br /> Site As <br /> DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY. WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone CONENIERCIAL <br /> �7 }, USTRIAL (a3 R/W <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTIE Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby applies for permission to ensmaoh on County Highway <br /> Right-of-Way on the 60E-5'r" silo of OLEY9,Nt „e s�66, <br /> City,State-Zip Code aPpro)d� f I moo <!Fv mile Sc4/7W of <br /> by installing 71W. <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES <br /> Contraotrn's License <br /> Acc=\Per AM\FmmlDtiv—yPavod&natage <br /> C <br />