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DEPARTMENT OF PUBLIC WORKS Received by sM' <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 11005 ISSUE DATE <br /> N AMOY - A-0 FEE DUE <br /> MR DATE DRIVEWAYS: <br /> Addrea � STREET �nGE 1e'A. , <br /> Lib ofli QUAD' NGc� <br /> City,State-Zi Code TYPE <br /> ORMS�u <br /> (Area Code)Telephone OTE ,, <br /> ,SITE Il�WOlR�A�T�N <br /> Nam <br /> J f� <br /> RNEWAY <br /> r , TYPE QUANnTY- WIDTHS <br /> City,S o-Zi Coda AGRICULTURE @ FRONTAGE <br /> (Area Code)Telepbone COMMERCIAL <br /> YNDUSTRIAL R/W <br /> rlDENCS •. <br /> �rn •,�QONTRACTrO�R n 1 PAVED FRONTAGE <br /> GTH: Ft <br /> � ( N(o`7 _� T <br /> The imdemigned hereby applies for permission to encroach on County MghWIty <br /> CA Rigbt-of-Way on 60 side of C.tX�'n8.2ia5G QD. <br /> C Zip Codc <br /> - �y ; / !nadie (,ate st of U,v/Go/ <br /> Z Sitio ,06R ,by instalhn8 -4*0 <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days- <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br /> AaeeaaTer AppTorm dvevayZaved frottage <br />