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DEPARTMENT OF PUBLIC WORKS CR#CR# <br /> �a8�o <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> PLIOFFICE USE ONLY <br /> ! JOB#11005 ISSUEDATE <br /> , i / APN 073 - /do - a FEE DUE /Ba <br /> Exp.DATE DRIVEWAYS: <br /> Addross STREET <br /> Gt�7 �tJ QUAD'S <br /> // City,State-Zip rOR <br /> -2716-J <br /> « <br /> S <br /> SITE r TjON <br /> ParcelOwnets Name <br /> Site Address <br /> DRIVEWAY <br /> 'Pity,State-Zip Code TYPE QUANTITY- WIDTHS <br /> AGRICULTURE ®FRONTAGE <br /> (Area )Telephone COhIlV MCIAL <br /> 11DUSTRIAL _. @ RIW <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH Ft. X WIDTFL• Ft <br /> Name <br /> Address The S��by mos forpenmisaion to encroach an County Highway ' <br /> Right-of-Way on the side of <br /> City,State-Zip Code appro3dmatelY`' <br /> s1L -#9 e*��,byinstalliag <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 Contractor's License <br /> Aom=Te:A"%FormD&msyNi id frwtage <br /> ' � C <br />