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-= DEPARTMENT OF PUBLIC WORKS �l ywu Uy <br /> DRIVEWAY AND PAVED F'R'ONTAGES OZSf! <br /> PERMIT APPLICATION <br /> .APPLICANT <br /> OFFICE USE ONLY <br /> Name 70B#11005 ISSUE DATE / <br /> �/.- ��'�.`%> N D IE- FEEDUE tea--/ <br /> Address $TREET_�,ME�,r'S � DRIVEWAYS- <br /> 6, <br /> RIVEWAYS:Lt <br /> VP City,State-Zip Cade TYPE QU`�- -�--_ + <br /> LAI, <br /> _(Arca Code)Telephone ORMS s� - t7 <br /> 26 e---o <br /> SITE Il�IFORMATION <br /> Parcel Owners Name <br /> Site Address <br /> LU 5 <br /> R1VfiWAY <br /> City,Stats- ip Code TYPE QUANTITY. WIDTHS <br /> L1 <br /> (Area Code)Tolophona COMI ERCIAL ®FRONTAGE <br /> .us <br /> ENCE <br /> CONTRACTOR <br /> PAVED FRONTAQE <br /> Name (}TIi Ft. X. WIDTH: <br /> Address <br /> 11w tndarkgnad hweby applies for permission to eruxoaoh as y <br /> Right-of-Way on the E silo of GCE ME►on CM��wa <br /> • City,State-Zip Coda ttppy�- / �, <br /> .E?DNo�eTN ofby installin <br /> t <br /> (Area Code)Telaphme 8 7�Li <br /> will commence on or about <br /> for approximatelyWalk <br /> days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this Project be self-installed? NO <br /> — YES .Contractor's Lioensc <br /> AaoesalPer ApplPocmlDrivlew,yPavad tmatage <br /> .5 <br /> iiI' '1 <br />