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DEPARTMENT OF PUBLIC WORKS Received by <br /> CPO <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DA <br /> Name APN,12L-0?-Z <br /> JAI-I% HPffLfbl56t4 bT.DATE DRIVEWAYS: <br /> i U? L Addm STREET t`IN�� A • <br /> srltni QUAD' _ *. <br /> Ci ,State-Zip TYPE �D <br /> 11`I CA Z� ORMS <br /> (Arca )Tcl OTE rr <br /> z� <br /> SITE INFpRMATION <br /> -J l <br /> . 3. PI�.1.J T►Ownm,n l%&mSite Addmss <br /> - L <br /> 'Mc'l�ro N m q 5215 DRIVEWAY <br /> city,S -zip Code TYPE QUANTITY. WIDTHS <br /> GRICULTURE @ FRONTAGE <br /> (Arae Code)Telophone CONIlvlERCIAL <br /> USTRIAL R/W <br /> -RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> GTIi Ft. X WIDTH Ft <br /> Now <br /> Address The undarsignod,hereby applies for permission to encroach on Cony Hi way <br /> Right-of-Way on the �,ysr side of 5YA)-ZLe ', 71 <br /> City,State-Zip Code apBY �Z- - " mile Sacrrr! of 88 <br /> .by installing l <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for appmximataly d"s- <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's Lioonse <br /> Acc=\Par AM\FamfW ivmayravad fialaV <br />