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Uvull1 1 V1' atu-4 JVA�vu• <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# 0 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERNM APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> kbVQ( JOB#11005 �� ISSUE DA <br /> ame APN W7 - -J����f FEE DUE <br /> 2 EXP.DATE DRIVEWAYS: <br /> c7-OL Addred STREET 'P�,s2cA4 17 ' <br /> 3DP4i _A.Cgmpe QUAD I _ <br /> City tate-Zip Code MEOwe/ <br /> CI✓ -A JvZ ORMS—551Z4U, �/7 <br /> Area Code)Telephone OTE <br /> �AM) q3 -3qW <br /> SITE INFORMATION 0 p`�� <br /> Parcel s Name I Vq' / <br /> ' Si es DRIVEWAY <br /> TYPE QUANTITY. WIDTHS <br /> �tX,State- i �C;ode� GRICULTURE @ FRONTAGE <br /> (Area-Code)Telephone COMMERCIAL a @� <br /> INDUSTRIAL I, <br /> smErICE ✓ <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X. WIDTH Ft. <br /> Nsme <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the We f_ side of Oct <br /> City,State-Zip Code approximately /,000 /mile . acrd of <br /> by installing Da� <br /> (Area Code)Telephone <br /> . Work <br /> will commence on or about for approximately days• <br /> w r'SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? — NO YES Contractor's License <br /> Acoew\Per Apff ormMrivewayPaved&nntage <br />