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Remvea by <br /> DEPARTMENT OF PUBLIC WORKS CR# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE O 5 /=? 10,9 <br /> ---- v I FEE DUE / <br /> DATE - DRIVEWAYS: <br /> s STREETn.+�,.�r <br /> �.ev7P QUADAX <br /> — " <br /> s <br /> Ci tate-Zip Code TYPETE. ( r— <br /> SrIEDWORMAT[ON <br /> Code)TSS elobow O <br /> P Ownci's Name ' <br /> �'��� RIVEWAY <br /> TYPE <br /> QUA. <br /> NTJ'1'Y. WIDTHS <br /> VDN <br /> City,State-Zip Code AGRICULTURE FRONTAGE <br /> (Arca Code)Telephone tONIlvlk?ItCIAL <br /> 17STRIAL, R/W <br /> 6?Z-, IDENCE <br /> CONTRACTOR PAVED FRONTAOE <br /> (} Ft. X WIDTH }?t <br /> Name <br /> Address The undersigmed hereby applies fir permission to a . a Coimiy-�Tigl�.way <br /> Right-of-Way on tt a ids Of 1 /! <br /> appoitnately of a t.siLcJ7'S <br /> City,Stats-Zip Coda ,by 8 <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 ConhaoWs License <br /> AoomTcr AppTormMdvemyPaved fradtap <br />