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COUNTY UY 5AN JUAQU LN Received by <br /> DEPARThffi OF PUBLIC WORKS Cit# 0 Z-P.,F.)4 f3 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APP CAN OFFICE USE ONLY <br /> 3013#11005 ISSUE <br /> ame ' - CYo7 - FEE DUEJ"l `=o <br /> �' f✓-�" DATE DRIVEWAYS: <br /> _ <br /> S C�� 57 ,�To N — =QUAD E.5 <br /> . s <br /> Ci State r <br /> W - - <br /> J �' _ <br /> IF Z—- b S 5 S�� R-1�- <br /> (Area Code)Telephone <br /> SITE INFORMATION <br /> Parcel Ownds Name <br /> i <br /> _ Site s DRIVEWAY <br /> . S / TYPE QUANTITY. WIDTHS <br /> City,State-Zi Code AGRICULTURE @ FRONTAGE <br /> G z`+ 6 colvnv�?RCIAI, <br /> (Area Code)Telephone USTRIAL @ R/W <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> �} Ft X WIDTfi Ft <br /> Name <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the side of SoNtJrP,�J4✓6 <br /> City,State-Zip Code approximately,r Sb' f /nft F+9�T of rw4 <br /> AtA5 ,by installing ZNN� <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 Contractees License <br /> Aoo—\P.w Ap ff ormUkivewayNved fiodap <br />