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xeceivca py <br /> DEPARTMENT OF PUBLIC WORKS CR# B" <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> \,/At p C JOB#11005 ISSUE DATE <br /> Name ApNleS- 32d 93 FEE DUE fleV <br /> C DATE DRIVEWAYS: <br /> STREET 1�lonrDY /.AKE ' <br /> Address QUAD A/E <br /> C C^ u� u <br /> City,State-Zip Code <br /> TYPE ­PW <br /> 2� FORMS 5 tuw, le-17 <br /> (Area Code)Telephone NOTE <br /> Sppfi_INFORMATION <br /> Parcel Ownets Nsmo <br /> Site Address DRIVEWAY <br /> 21 DRIV TYPE QUANTITY. WIDTHS <br /> City,State-Zip Code GRICULTURE @ FRONTAGE <br /> .f � 2-Y- <br /> 7- COMMERCIAL <br /> (Area Code)Telephone USTRTAI. @ R/W <br /> �IDENCE . <br /> CONTRACTOR PAVED FRONTAGE <br /> GTH: Ft. X WIDTH: Fk <br /> Name <br /> Address The �°0d hereby applies for pOZmission to encroach en County Highway <br /> Rigbi-of-Way on theappro3dma <br /> tely,i Sy feet/mile E der of �E/n �• <br /> City,State-Zip Code ,bye 9u7 <br /> (Area Code)Telephone <br /> Werk <br /> will commence on or about for approximately dam• <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br /> Aco=\Per App\Fo=MdvamyPaved fraarage <br />