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DEPARTMENT OF PUBLIC WORKS xecatvea Py- s- <br /> • CR# 02 4s.� soo <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11805 bSSUE DATE <br /> 6' Name APN aaS - 10.3 - 07 FEE DUE Jf/&0, eco <br /> DATE DRIVEWAYS. <br /> Address STREET ve AvgN06 <br /> 44 <br /> f �Tx KTON QUAD �4 • <br /> city,State-Zi Code r(O�TE <br /> (Area Coda)Telephone U pipe, <br /> SITE INFORMATION <br /> Parcel Owner's PEW <br /> Site es RIVEWAY <br /> � S <br /> City,State-Zip Code TYPE QUANTITY. WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Aron Code)Telephone COMMERCIAL <br /> INDUSTRL4kL R/W <br /> c � IDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> 1ENGTH!- Ft. X WID1Ti Fk <br /> Name <br /> Address The undersigned hereby applies far permission to encroach on County Highway ' <br /> Rigbt-of-Way on the side of gaff= .A6 <br /> City,State-Zip Code approximately,, /,tare SovTN of /�Y ZT� <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days- <br /> SKETCH(Separate sheet may be mibmitted) <br /> Will this project be self-installed? NO YES Contractor's License <br /> AoomTer App\Fmm\DdvvmyPaved fiautage <br />