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COUNTY Ur 5AN rupquu- R by <br /> -r— <br /> DEPARTMENT OF PUBLIC WORKS <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLTVATTON <br /> OFFICE USE ONLY <br /> APPLICANT 5 ISSUE DATE <br /> JOB#1100 FEE DUE <br /> Name / -�— DRIVEWAYS: <br /> DATE i <br /> X88 ERR STREETc'J � QUAD. <br /> - 8383 C�EVAc/€� WTYPE <br /> City,State-Zip Code RMS <br /> TaC-AWE A 752Io OTE <br /> (Asa Code)Telephone <br /> Y' <br /> SrMi55RMATION <br /> . parol Oi�vnets Name . <br /> pNSlJEL,1! �eQA,No <br /> Site Address RIVEWAY QUA WIDTHS <br /> 2�1(0o E J dEtN T TYPE @ FRONTAQE <br /> City,State-Zip Com (}RICULTURE <br /> 11 2111, <br /> 'T oc wT(Am Code)Telapb" USTRIAL R/GV <br /> •IDENCE '. <br /> PAVED gRONTAC}E � <br /> CONTRACTOR QTH: Ft. X WIDTH: <br /> Name The Eby applies for siM to epi ash on Co�tY I�Sh Y <br /> sidear <br /> Address Right-of-Way oa the mile ���r ofD12Jzlso#— <br /> � y <br /> City,State-Zip Code /qVE •by <br /> (Area Code)Telephone <br /> Work <br /> d"s <br /> will commence an or about <br /> for approximately ' <br /> SKETCH(Separate shoot May submitted) <br /> ----------- <br /> Will alis project be self wstalled? _NO YES Contractor's License <br /> Accm\Par Aw\Focm0&0myPaval fiadage <br /> � 1 <br />