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- ' VV.+IAY.I A Vx yr aim✓ a.a.{v++.• <br /> ?eccived`)y am <br /> DEPARTMENT OF PUBLIC WORKS ,R# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE; / / <br /> VName N?--K - 21� - 5��54 FEE DUE <br /> �i GT0.2 A 1—to EXP.DATE DRIVEWAYS: <br /> Address STREET /!/Ei2 ,�D , <br /> �e B 92S iGo�/ QUAD _ <br /> City,State-Zip,C TYPE <br /> A) A <br /> FORMS <br /> Z©� ��Code) l�cphc,ne NOTE <br /> SIM INFORMATION <br /> P Own es Name ' <br /> A c © <br /> Site Address DRIVEWAY <br /> �TYPIvEIlvIHtCIAL <br /> QUANTITY W <br /> IDTHS <br /> Ci tae-ZCAGRICULTURE @ FRONTAGE <br /> Code)Telephone o>qr- <br /> z USTRIAL @ R/W <br /> rMENCE <br /> Zr <br /> CONTRACT4bR PAVED FRONTAGE <br /> LENOTEL Ft. X WIDTH:. Ft. <br /> Name <br /> Address The undersigned hereby applies far permission to encroach on County Highway <br /> Right-of-Way on the side of //.Cel ED, <br /> City,State-Zip Code approximately 4 zcloo Not 421ift EA 3-r of ? � <br /> .2a .by' ) <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 Contmotoes License <br /> AoccaTer App\FormMdvavayNved fodalp <br /> l/V <br />