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l.VUIN1 I Ur DtUN JV1wU11V --et 'rte_ ys,e <br /> DEPARTMENT OF PUBLIC WORKSReceived byCR# A <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> AP LICANT OFFICE USE ONLY <br /> x 9-12 n s G JOB#11005 ISSUE DATE ! / <br /> Name APN YIDJ� - - ZS FEE DUE / l> <br /> - i ,) EXP.DATE DRIVEWAYS: <br /> ss N STREETAl,t 6' V 14 ' <br /> AREA A4509A,7X619 QUAD S, • <br /> Ci e-Zi jj TYPE ` <br /> FORMS <br /> (Area Code)Telephone NOTE <br /> k � SITE INFORMATION <br /> Parcel Owner's Name D <br /> Site Address <br /> DRIVEWAY <br /> City.State-Zip Code TYPE QUANTITY WIDTHS <br /> <�p cj32 _ GRICULTURE @ FRONTAGE <br /> (Arca Code)Telephone COMMERCIAL <br /> 1NDUSTRL4LL @ R/W <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> GTH: Ft. X WIDTILL• Ft. <br /> Name <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the W T side of U0 t6 fly <br /> City,State-Zip Code approximately 1mile 5o a rK of w6: Tr <br /> apo N ph. ,by installing �•J <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days. <br /> SKETCH(Separate shoot may be submitted) <br /> N <br /> c � <br /> 3 <br /> LtS per,- <br /> W_y N � <br /> L,) L <br /> LL3' 7 <br /> .n r-- <br /> o.. <br /> c w <br /> F N � <br /> Will this project be self-installed? -NO YES Contractor's License <br /> Aoc=\Per App\Form\DrivewayPaved&outagp <br />