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DEPARTMENT OF PUBLIC WORKS xecelvea by <br /> CRO SL <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> PSTRJEET . <br /> 011005 ISSUE DA <br /> Name ;09 - 3� _ O FEE DUE�� <br /> f, DATE DRIVEWAYS: <br /> s 19xrV P_D, • <br /> f <br /> , QUAD <br /> Ci Ci s p Code TYPE <br /> G. OM <br /> RS r/7 <br /> (Area Code)Telephone OTE <br /> ® '- <br /> SITE INFORMATION <br /> P 1 Name <br /> 30 <br /> r� i� DRIVEWAY <br /> C ,S Zip TYPE QUANTITY- WIDTHS <br /> t}RIC TUBE FRONTAGE <br /> COMMERCIAL <br /> (Area Code)Telephone VNDUSTRIAL R/W <br /> SIDrFENCB <br /> CONTRACTOR PAVED FRONTAGE <br /> GTH Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby applies for permission to encroach an County Highway <br /> Right-of-Way on the side of <br /> City,State-Zip Code fly,c A,,'0,eT�f/ of Z.15 e53L% S <br /> y .by <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days- <br /> SKETCH(Separate aheet may be submitted <br /> Will this project be self-installed? NO YES Contractor's License <br /> Aooem\Per App\Focm\Dkiv wayZ&ved fimftge <br /> �� 0 <br />