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xecelvea Dy <br /> DEPARTMENT OF PUBLIC WORKS CR# d <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> ACANT OFFICE USE <br /> PP ONLY <br /> ..� <br /> L Ct/� JOB#11005 ISSUE DATE <br /> . FEE DUE /P a <br /> Name N 2 0 - 05-0- �. <br /> .DATE DRIVEWAYS:_32 <br /> Addross STREET 151 X TN 57- <br /> /I 4A .9cy QUAD_ <br /> City,S Cade TYPE <br /> D j• �O 3`S� oRMs - <br /> (Area Code)Telephone NOTE <br /> SITE WORMATION nn-- <br /> . p s Name `. <br /> Sito s n RWEWAY <br /> r Q �� / TYPE QUANTITY- WIDTHS <br /> City,State- ip Code AGRICULTURE @ FRONTAGE <br /> - <br /> (Area Code)Telephone C;OIVIlviERCIAL <br /> USTRJALRESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENG11LI.Ft. X WIDTH: Ft <br /> •Name <br /> Addnss The undersigned hereby applies for peamission to encroach on County 13ighway <br /> Ri&-of-Way on the W EST side of N ST. <br /> appy.rO mile of l� 4 At,' <br /> City,State-Zip Code by installin8 <br /> (Area Code)Telephone <br /> Work <br /> days- <br /> will commence on or about for approximately <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br /> Acceas\Per ApplFocm\DcivmayPawed fia talp <br />