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veva.a a a.,w <br /> DEPARTII ENT OF PUBLIC WORKS Received by <br /> Cit# D <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOS#11005 ISSUE DATE, <br /> NameNlS� - a-- Af FEE DUE <br /> (�f7 /U. C� .DATE DRIVEWAYS: <br /> Address STREET .tI/�'PAS . <br /> QUAD' 6 S <br /> City,State-Zip Code TYPE ` <br /> 2 d <br /> C:) -1 <br /> 7ORMS ;;F/7 <br /> Ares<Code)Telepbone OTE <br /> Dl- <br /> SITE RMATION <br /> Parcel Owners Name ` <br /> 9 <br /> Site Address RIVEWAY <br /> f Z TYPE QUANTITY- WIDTHS <br /> City,State-Zip Code GR13CULTURE @ FRONTAGE <br /> (Area Coco)Telephone COMMERCIAL <br /> PNDUSTRL4L@ R/W <br /> IDENCE — <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGnL-________Jt Ft. X WIDM Fk <br /> Name <br /> ?07 AlO <br /> Address The undersisned hereby applies for pormisaiM to encroach on County I ighway <br /> rp " Right-of-way on the 5'A'nrT- side of AN?Z57ebS i96. <br /> city,state-zip Code approximately 3�O kaffe ,le erN of 6A"sr' <br /> Y n! JT ,byinstalling PO. <br /> Area code)Telephone <br /> Work <br /> will commence on or about L for approximately days. <br /> SKETCH(Separate sheet may be jr <br /> Ina <br /> Will this project be self-installed? NO YES Contractor's License <br /> Aco=Tcr ApplFormM)dvewayPaved frontage <br /> 1 <br />