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DEPARTMNT OF PUBLIC WORKS xeMY vy -� <br /> E <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE <br /> Name -a50-0 FEE DUE <br /> f 1 G Z i JI e-T DATE DRIVEWAYS: <br /> Address STREET c3d��� # <br /> QUAD-�— <br /> City,State-Zip Code rN.A)7 <br /> S N S <br /> (Area Codd)Telephone <br /> SITE RWORMATION <br /> Im ZW C <br /> 1'-Parcel Owners Name <br /> Site Addm4S.O DRIVEWAY <br /> TYPE QUANTITY- WIDTHS <br /> Ci State-Zi S Code <br /> -316 — ! AGRICULTURE @FRONTAQfi <br /> �M1�RCIAL <br /> (Arca Coda)Talephama USTRIAL R/W <br /> IDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> QTH Ft. X WIDTH Ft. <br /> Name <br /> Address The mdersi pwd hermby applies for parmission to encroach on County Highway <br /> Rigbt-of-Way on the _side of 23/4P <br /> City,State-Zip Code approximately of STQ,tke�tZ <br /> 9,e1 LAf ,by in - <br /> (Area Code)Tdaphame <br /> Work <br /> will eommenx on cr about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br /> AooeaslPm A,VTb mWrivamyPavra f stage `•, <br />