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' -4Vvaa a ya�vaa• - <br /> DEPARTMENT OF PUBLIC WORKS CRR n"aby <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE} — <br /> N + DATE _ 9 FEE DUE <br /> DRIVEWAYS: <br /> Addcea STREET <br /> 23 Aco.w.,o o QUAD'S_ <br /> A <br /> City e-Zi ` TYPE <br /> 2 RMS SS ww} t2:� <br /> (Area Coda)Telephone OTE <br /> AID P l PG <br /> SITE INFORMATION <br /> Parcel Ownces <br /> Site Address DRIVEWAY <br /> 2$ TYPE QUANTITY. WIDTHS <br /> City,S -Zip Code AGRICULTURE @ FRONTAGE <br /> `S <br /> (Arae Colo)TelephoneC0lDdERCIALUSTRIAL R/W <br /> RESIDENCE <br /> i <br /> CONTRACTOR PAVED FRONTAGE <br /> GTI: Ft. X RTIDTIi Ft <br /> Name <br /> Address The undersigned heraby applies for permission to encroach on County Highway <br /> Right-of--Way on the dlo,e'r' side of Ce eP <br /> City,State-Zip Code aPplO ely V-aie•-S� of 0tR- <br /> rgee_T. ,by installing 7�G 2 <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 /> Aocem\PcrApplFo m dvmayPaved$mtage <br />