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c;UUN I Y Ut' JAN JUAJUM <br /> DEPARTMENT OF PUBLIC WORKS Received by JI!E: <br /> CR#DRIVEWAY AND PAVED FRONTAGES --Q o h�P <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> ti _ "04 A oAJOB#11005 ISSUE DATE <br /> I.Y��D L` .E� ti r r I� IQ d APN A`�? -�-� FEE DUE <br /> EXP.DATE DRIVEWAYS: <br /> 1 Address STREET ,GCS « <br /> I"X1 L ZaPI QUAD_M W_ « <br /> City,State-Zip Code TYPE 1c.> « <br /> SSS 5, FORMS_ ,Q-/7 <br /> (Area Code)Telephone NOTE ' <br /> c� !QOSITE INFORMATIONp s ey <br /> J J 8 T <br /> Parcel Owners Name <br /> / S 2" <br /> Site Address <br /> - r DRIVEWAY <br /> City,State-Zip Code TYPE QUANTITY. WIDTHS <br /> g j AGRICULTURE FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL Q R/W <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> Name <br /> GTH: Ft. X WIDTH: Ft. <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the or�%i side of xel:,h f /��,%+ <br /> City,State-Zip Code approximately— �Zo a /mile Eras f of Way� arse `fid <br /> byinstauing <br /> (Area Code)Telephone <br /> will commence on or aboutWork <br /> for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? --NO YES Contractors License <br /> Aooe-IP-ApplF-mOnvewayf wd fimug. <br /> i <br />