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L VU.N l r yr aruv dvr U-U'4 -- —t <br /> - DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# 0307 Zo <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERIM APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB#11005 ISSUE DATE <br /> NAPN a13 _lbs - ;L3 FEE DUE <br /> EXP.DATE DRIVEWAYS: <br /> �s STREET 7,�--Z- /1D• ' <br /> LA/1 AREA xn!C`T,v QUA <br /> City,S -Zip Code TYPE Y7W # <br />/ Gj Ll ORMS 514,1111 -/ <br /> I ( ea Code)Telephone� OTE <br /> Zai �'�33 -7 <br /> SITE INFORMATION <br /> DRIVEWAY WIDTHS <br /> (P ty,State- TKwe TYPE(}RICULTURE QUAY Q FRONTAGE <br /> (Ams Code)Telephone COMMERCIAL <br /> USTRIAL @ R/W <br /> SIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the Soc1TN side of 'w-we7w ,ec. <br /> City,State-Zip Code approximately /5224 e mile -CAST of TPAf MMIK <br /> /f AC, ,by installing Z�r.J <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 /> Aocess\Per Apff orm\Drivewayfaved&-outage <br /> i <br />