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Received by <br /> DEPARTMENT OF PUBLIC WORKS CR# .':;01J 2 7 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> r APPLICANT OFFICE USE ONLY <br /> ) L/ e?q5 VJOB#11005 ISSUE DA�Name fJ S_- O - 3FEE DUE 1 <br /> 5WA�"D DATE DRIVEWAYS: <br /> EET EtS�,eN� D' ' <br /> QUA — s <br /> e�ty,State <br /> -ZIP <br /> Code TYPE <br /> tJ <br /> Lzo9 3�Y_ oRNts <br /> (Area Code)Telephone <br /> OTE O <br /> 777 <br /> SITE INFORMATION <br /> Parcel Owners Name ` <br /> 13o1 � E � <br /> Site Address DRIVEWAY <br /> TYPE QUANTITY- WIDTHS <br /> City,State-Zip Code GRICULTURE ✓ @ FRONTAGE <br /> (Area Code)Telephone CONOR RCI AL <br /> ]NDUSTRLAL R/W <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTlE---------Yt. X WIDTH Fti <br /> Name • <br /> Address The imdersigoed hereby applies fa permission to encroach on.County Fiighovay <br /> Iti&-of--Way on the_ side of <br /> City,State-ZiP Code ��y ' A",t <br /> lJT of <br /> .by installing <br /> (Area Code)Telephone <br /> Wack <br /> vvM commence an or about for approximately days- <br /> SKETCH(Separate shoot may be submitted) <br /> Will this project be self-installed? NO YES Conhwtor's License <br /> AccewTor AppTarmMrivmsyroad fivdap <br />