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DEPARTMENT OF PUBLIC WORKS ReceiVea Dy 1j" <br /> CR# e) <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE <br /> Name APN 1633 - 3;20 -.7'? FEE DUE A183 <br /> rL lC Ls ENP.DATE - DRIVEWAYS: <br /> Address STREET r2Ei.D fZ'a • <br /> LT" 5(c+ LI�(7JEN QUAD'_ Ale <br /> 2� City,State-Zip Code TYPE �� s <br /> 17 <br /> (Area Coda)Telephone OTE <br /> SITE INFORMATION <br /> Pared Ouvm es Name <br /> Site Address <br /> �1 RIVEWAY <br /> City,State-Zip Code TYPE QUANTITY- WIDTHS <br /> GRWMTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> USTRiAL R/W <br /> - IDENCE - <br /> CONTRACTOR PAVED FRONTME <br /> GTI- Ft. X WIDTH: Ft. <br /> Name <br /> go <br /> Address The undersigned hereby applies for permission to enamaeeh on.County I-fig may <br /> Right-of-Way on the . side of >im, <br /> City,State-Zi Code app t1y 150412-w of NDS_ <br /> 9 362 <br /> 1-4AA5 ,by instalffig Z>-c> <br /> (Area Code)Telephone <br /> 2' <br /> wWork <br /> ill commence on or about for approximately days- <br /> SKETCH(Separate shoot may be submitted) <br /> Will this project be self-installed? NO YES Contractor's License <br /> AooessTar AW\FmmWdvmayPawd fi outage <br />