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--- - Received.by <br /> DEPARTMENT OF PUBLIC WORKS CR# :_ ALF F_ <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE <br /> Name X763 - S - 02- FEE DUE td/SIO <br /> DATE DRIVEWAYS: <br /> �vi �✓!G 1' STREET y19r21VF� L�� <br /> �lO l"f Address S*,C / T QUAD' d,19 t <br /> City,State-Zip Code TYPE <br /> 5 1 O FOPUMS 55 54w <br /> (Area Code)Telephone NOTE <br /> 20 F� 7 <br /> SITE INFORMATION <br /> Pareel Owers Name <br /> --Lao 2- E. L <br /> Site Address DRIVEWAY <br /> lio P 9 TYPE QUANTITY- WIDTHS <br /> City,State-Zip Code AGRICULTURE @ FRONTAGE <br /> (pros CoCOMMERCIAL <br /> de)Tolophone USTRIAL Q R/W <br /> IDENCE <br /> DM <br /> CONTRACTOR ' PAVED FRONTAOE <br /> GTFLFt. X WIDTFL <br /> Name <br /> The wdcrsig hereby applies for permission to encroach can County Highway <br /> Address Right of-Way oa the No eT/I side of fLO,6W y /4�_ ._ <br /> approximately', Z 00 ER5?- of ST <br /> City,state-zip Code .by installing <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 Conhactoes License <br /> Aooe nTer ApplFormMdv myZzved&mage <br /> II <br />