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I:UUN 1'Y Ur aAiv rUt",zuux <br /> Received by _ <br /> DEPARTMENT OF PUBLIC WORKS CR# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 _ ISSUE DATE�-- <br /> Name N r - 3Z - 02'— FEE DUE 4P,70DATE DRIVEWAYS: <br /> STREET -rr ,elyr7'E 33 ' <br /> QUAD�- <br /> Ci v e-Z, TYPE -!7 <br /> (Area Coda) ORMS <br /> Telephone OTE <br /> SITE BOORMATION <br /> Parcel Owners Name <br /> O AZO ' <br /> Site Address RIVEWAY <br /> T)k A `{ C-A L TYPE QUANTi1'Y. WIDTHS <br /> City,State-Zip Code AGRICULTURE FRONTAGE <br /> 2 '� - 32-0- COMMERCIAL - <br /> (Area Code)Telephone MIDUSTRIAL @ R/W <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> Q Ft. X WIDTH Ft <br /> Name <br /> Address The undersigned hereby applies for permission to encroach on.County ITiighway <br /> Right-of--Way as the EAST- side of E!;r, P-T, 33 <br /> approximately.c 3cFt) mile ,1Q FrH of 73A►T,�a <br /> City,State-Zip Code 0-6000A M ge .by installing <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days- <br /> SKETCH(Separate shoot may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br /> Acma Ter 4p\j?"mMd%, vayPa%Fed&artaip <br /> CJ <br />