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DEPARTMENT OF PUBLIC WORKS Received by- <br /> CRO <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> C-. JOB#11005 ISSUE DATE <br /> No53 -_190 _ FEE DUE <br /> E(P.DATE DRIVEWAYS: <br /> STREET �tr�✓.+9A.y 46W xi✓ s <br /> 7;1 <br /> C' State- i TYPE ` <br /> ORMS <br /> /(Area Code)Telephone OTE <br /> $ITAffORMUTION <br /> P + <br /> Sz 10 <br /> DRIVEWAY <br /> ity,State-Zip Coda TYPE QUANTITY- WIDTHS <br /> AGRICULTURE @ FRONTAGE <br /> (Arca Codd)Telophase COI�r1MERCIAL <br /> Q USTRL @ R/W <br /> CONTRACTOR PAVED FRONTAGE <br /> GTIi Ft. X WIDTH: Ft <br /> Name <br /> Address The undersigned hereby applies for permission to encroach an County Ffighway <br /> Rigbt-of-Way on thaew-n-,' side-f bl- <br /> City,State-Zip Coda fly<c Z90 ' _ 509W of eZe W1EA,-rS <br /> ?2D_ <br /> __,by installing u1. <br /> (Area Code)Telephone <br /> Work <br /> will commenm on or about for approximatoly days- <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br /> a4ccmXPcr AppTbrmlDdvWMyPavaa 8notage <br />