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7.ece'.ved1?`1' <br /> DEPARTMENT OF PUBLIC WORKS "Pa -5 <br /> . DRIVEWAY AND PAVED FRONTAGES <br /> APPLICATION <br /> Y� OFFICE USE ONLY <br /> APPLICANT ISSUE DATI3 <br /> b C p,� <br /> EN. <br /> 0 11005FEEDUE_ <br /> NxM0 63 - 176 - 48)DATE D)tIVEWAYS: <br /> STREET UA-J--.A <br /> Euv "� S S't�GKtt�n/ QUAD <br /> pity,state-Zip Code �S� S �/ TYPE ,�17 <br /> QFORMS 9S <br /> (Ana Code)Telephone NOTE <br /> SITE MORMATION . C <br /> S(ASCM G� C VJ <br /> Panel Owners Name <br /> Site Addret � DRIVEWAY <br /> TYPE QUANTITY_ WIDTHS <br /> Citi.State-Zip 040 AGRICULTURE @ FRONTAGE <br /> 3 ^ ID,(S . COMMERCIAL <br /> (Ana Code)Telephone bNDUSTRL4L @ R/W <br /> rMMICE <br /> CONTRACTOR A PAVED FRONTAGE <br /> GTIi Ft. X WIDTH: <br /> Name <br /> The undardg[wd hereby applies for permission to encroach on County NWhway <br /> Address Right-of--Way on the AV e7W side of SJN 10>. <br /> aP1 y 4 mile 2__ of <br /> City,State-Zip Code ,by• �lc> <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days- <br /> SKETCH(Separate sheet may be submitt4 <br /> Will this project be self-installed? NO YES Contractors License <br /> AoceseTer App\FormodvemyPaved fie tage <br />