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DEPARTMENT OF PUBLIC WORKS <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPUCAM OFFICE USE ONLY <br /> A JOB#11405 ISSUEDATE�—! / <br /> Name APN 1-37- - C00- -91_ FEE DUE <br /> 1hvL vAUALCfA-rLe EXP.DATE DRIVEWAYS: <br /> Address STREET T rYlAs,�i91.0� ' <br /> STfli.�.c--t-wy� CA 459 7s-re.� QUA' ofio5 <br /> _ ; <br /> City,Stateem(o-Zip Code rYPE <br /> 'L $ S(Area Code)Telephone -- <br /> SrM INFORMATION <br /> Parcel Ownds Name <br /> Site Address G 7A�.�.. RIVEWAY <br /> �O lk OMI TYPE QUADTfiTY- WIDTHS <br /> City,State-Zip Coda FRONTAGE <br /> STOGAP CA 9 2� G <br /> (Area Co(l�o)/Telephone USTRIAL - R/W <br /> ! 0 V►O 2- ��. IDENCE - <br /> CO CTOR PAVED FRONTAGE <br /> T Q1Ti Ft. X WIDTH FL <br /> Name <br /> ' �70 no undersigned hereby applies for pacm nOn to encroach an County Highway <br /> ��- Address C - s 2 g Right-of-Way on the 14 sick of 1G 0,114 <br /> City,State-Zip Codc �Y_ fc milt S of e t <br /> by inn t <br /> (Area Code)Telephone <br /> � , 24P Cd <br /> Work <br /> will commence on or about 1CU for approximatelydays- <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br /> Acoms\Per App\Form dvavayhncd f adage <br /> ' t <br />