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I.VUlV 1 1 Vi' otu-1 JllK%,1Vi1v <br /> DEPARTMENT OF PUBLIC WORKS Received by�– <br /> CR# O 50(o 9 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> CANT OFFICE USE ONLY <br /> PLI <br /> f CANT N JOB#11005 ISSUE DATE <br /> Name APN 04aS -Oro - -2-7 FEE DUE o0 <br /> C�Sr G EXP.DATE DRIVEWAYS: <br /> Address STREET /6 R/GE ' <br /> P O. A- QUAD _ • <br /> City,State-Zip Code TYPE s7crs <br /> d a6 ,2Sg' ORMS <br /> (Area Code)Telephone OTE <br /> SITE INFORMATION NOAN <br /> Parcel Owners Name <br /> 4149 1,191A,b <br /> Site Address RIVEWAY <br /> e,-. 64#r IV I LC RAAfh TYPE QUANTITY. WIDTHS <br /> City,State-Zip Code GRICULTURE @ FRONTAGE <br /> 1'ul IAO igutCOMMERCIAL <br /> (Area Code)Telephone INDUSTRIAL @ R/W <br /> SIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH--- Ft. X. WIDTH: Ft. <br /> Name <br /> The undersigned hereby applies for permission to encroach on County Highway <br /> Address <br /> Right-of-Way on the A/01- �6 side of Eio h M/e Lead <br /> City,State-Zip Code approximately feet/mile AS f' 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 /> AccenTer Apff ormOrivewayPaved fro loge <br /> i <br />