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DEPARTMENT OF PUBLIC WORKS Received by <br /> DRIVEWAY AND PAVED FRONTAGES CR# 03 Lp 9'7 <br /> PERMIT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE <br /> e APN/99 -&0 - FEE DUE <br />}7 EXP.DATE DRIVEWAYS: <br /> 1Address STREET _%=6xzb , <br /> City,State sq 2- AREA <br /> -Zip Code TYPE -1—W G�i9/1JP QUAD {/5 <br /> 79 5 3c) ORMs <br /> (Area ode)Telephone OTE <br /> SITE INFORMATION <br /> Parcel s Name <br /> fee- <br /> 7 itess <br /> o joaDRIVEWAY <br /> Ci State-ZipTYPE QUANTITY WIDTHS <br /> (r a\ vY� o�3 t AGRICULTURE @ FRONTAGE <br /> (Area Code)Telephone COMMERCIAL <br /> INDUSTRMLL @ R/W <br /> RESIDENCE <br /> CONTRACTOR PAYED FRONTAGE <br /> LENGTH: <br /> Name Ft. X WIDTH Ft. <br /> Address The undersigned hereby applies for permission to encroach on County I•iighway <br /> Right-of-Way on the side of �:7L Dorado , <br /> City,State-Zip Code approximately SSo /mile of <br /> by installing - <br /> (Area Code)Telephone <br /> will commence on or aboutWork <br /> for approximately days. <br /> SKETCH(Separate sheet may submitted) <br /> Will this project be self-installed? NO _ YES Contractor's License <br /> AoorssTer App\Form\DrivewayEaved&artage <br />