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wuN i r yr W-11v J Vt",Z uv Received by <br /> DEPARTMENT OF PUBLIC WORKS CR#030 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DAT <br /> N APN Q(g3- 220 - Z< FEE DUE /SC7 <br /> c, c EXP.DATE DRIVEWAYS: <br /> Address STREET —12" <br /> A-ay`__\C460 AREAD/ QUAD A145 <br /> City,State-Zip CodeTYPE A-V O ORMS <br /> (Area Code)Telephone OTE <br /> ZOq 1o07- SYS�T C � <br /> SITE INFORMATION <br /> Parcel Owners Name <br /> S4 z�"vV, — 4 S A_(S �-c <br /> Site Address Rrv% SAY <br /> TYPE QUANTITY WIDTHS <br /> City,State-Zip Code AGRICULTURE ✓ @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRIAL R/VJ <br /> SIDENCE <br /> CONTRACTOR LENGTH: <br /> FRONTAGE <br /> GIH: Ft. X. WIDTH: Ft. <br /> Name <br /> The undersigned hereby es for permission to encroach on County Highway <br /> Address <br /> Right-of-Way on the o A side of 76&&,, Oplon, .?q& <br /> City,State-Zip Code approximately e /mile SGS of <br /> by installing <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 /> Aooe ss\Per AppWormOrivewayPaved frontage <br />