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DEPARTMENT OF PUBLIC WORKS 10mveo,°y <br /> CRO <br /> .DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPIdCANT OFFICE USE ONLY <br /> JOB#1 5 ISSUE DATE <br /> Name N I�.S - 100- 07 FEE DUE /255 <br /> 1��✓�' EXP.DATE DRIVEWAYS: <br /> Address STREET - s <br /> S O 9 S S�3GrL7�N r"� rYl QUAD' SE + <br /> ) City,State- ip Code TYPE •222-1 <br /> s <br /> Lodi �YQ ORMS V -17 <br /> (Area Code)Telephone OTE <br /> ao9� 373-c o <br /> SITE INFORMATION <br /> Parcal Owners <br /> .79 w, Ale-6.v fD, <br /> Site� tiCN C>4 -14 95231 DMEWAY <br /> City,State-Zip CodeGRTYPIQUAY WIDTHS <br /> CLTLTURE C�FRONTAGE <br /> (Area Code)Telephone <br /> COMMERCIAL <br /> USTRIAL R/W <br /> IPMIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> GTH Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersignefl hareby applies for permission to encroach oa County Mahway <br /> Right-of-Way on the 4&21im silo Of . <br /> City,State-Zip Code aPP�y,f � -war Gi93r of l-Cr.�' XY 7 <br /> by installing--�?,J• <br /> (Area Code)Telephone <br /> Work <br /> will oommc=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 /> AcoesslPer ApplFormlDrivewayPaved&nuta®e <br /> �0 <br />