HomeMy WebLinkAboutRAP9768 - RAP Permit / Conditions PERMIT
Mason Count�yy Road Department Permit Number:
411 North F, h Road Name :
P.O. BOX 18 0 Road Number :
Shelton, WA 98584 RECEIcation: D33oa
Subject to all terms, condit%sl vhvrovis ions written or printed below
or on any part of this form,
Permission Is AMSOFUNTY PUBLIC WORKS
Hereby Granted To: i C k /`'x f'4 o yr /�a LJ d A AV au ear, S
P o Ao x l if CAY.If�
c`-thor►ad W QoB /'eferS
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To Install: �C n . L� �aM�C 1 `1.223 fQ7� >�
cG S S f �., crC le r-d 9 + fr,
Location: - ,ro / L ee.ts IPc(- ShNC l,✓x It,
Nip/3 P14i � O)l N�4r� 9- Ri541 a � ��1�fe St� ( �tafsyc�° C 1ti4oh Leeds A!?
Parcel Number:
Legal Description:
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A bond in the amount of $ accompanies this permit.
Receipt Number: Check Number:
Contractor z
Address .
City/St/Zip:
Phone .
Lic. Number: Expires:
Specifications:
Access to be graveled to property line with 3"depth of dean gravel. Culvert to be aluminum,concrete or polyethylene.
Access will be staked and flagged by Permittee for pre-inspection. Culvert will lay in tine of ditch.
Access WE be pm-inspectod by this office prior to installation. Culvert to be minimum of 12"diameter b
Access installation shall be in accordance with county specificatans Y 30 kngtft.
.
Comnm'cW/Mtlti uate access shall require STOP Signs,installed In conformance to the MUTCO manual,at intersection with county road.
No work shall be done under this permit until the party to whom it is
granted has communicated with and received instructions from the road
supervisor at: 360-427-9670 ext. 450.
RESULTS OF SITE INSPECTION: See Attachment "A"
This permit shall be void and bond forfeited to Mason County unless the
work herein contemplated shall have been completed on or before:
Dated at Shelton, Washington, this day of
Issued by:
Title:
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Mason County
Dept.of Community Development
P.O. Box 578
Shelton, WA 98584
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Reference Number(s) of related documents
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Grantor(s)(Last,First and Middle Initial) I
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Additional grantors on page
Grantee(s) (Last.First and Middlelnil:al)
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Legal Description (aDbreviatedlorm i.e.lot.block.plat or section,township,range,q_anef:c.:arte.,
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Assessor's Property Tax Parcel/Account Number
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Additional grantors on pagee
The Aue,ar:Recorder will rely on the information prov.oeo on this form Tne staff will not read the docimerA lc.er,!,tr•.a i=:
ca pleleness of the utde■ing information provided herein