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DEPARTMENT OF PUBLIC WORKS CR#- <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> D/GGoAV /Yl/.�J°�`� JOB#11005 ISSUE DATE <br /> Name N ly/ -J _- ;0 FEE DUE_ <br /> w kEXP.DATE DRIVEWAYS- <br /> s STREET- <br /> G92 QUADit/_x�' ^+ <br /> City,State-Zip Code TYPE Dui <br /> oR � <br /> (Area Code)Telephone OTE 1A 10 <br /> SITE WORMAIION <br /> �lEiVUK2�D '� l �/Cf" <br /> Parcel Ownets Name <br /> 2 N• G.QtiE .ep' <br /> Site <br /> 5?k v e R DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY_ WIDTHS <br /> AGRICULTURE ®FRONTAGE <br /> (Area Code)Telephone COI DAMCJAL <br /> USTRIAL R/W <br /> ENCE T— <br /> CONTRACTOR PAVED FRONTAGE <br /> GTI: Ft. X WIDTH:. Ft. <br /> Name <br /> Address Ile tonged hereby applies for pamiSeM to owroaah as County Highway <br /> Right-of-Way on the 6,b i side of Al <br /> City,State-Zip Code approximately<< O Ewe .r/D.e7�Y of GU Z <br /> by installing Z>44. <br /> (Area Code)Telephone <br /> Wank <br /> will commeam an or about for approximately days. <br /> SKETCH(Separate sheet may be sd)mittod) <br /> Will this project be self-installed? NO YES Contractor's Lioense <br /> Ao mTcr AVpTormDri"myEaved fimtage <br /> ii <br /> 7 <br />