HomeMy WebLinkAboutRAP6102 - RAP Permit / Conditions - 6/19/1996 PERMIT
Road Department Permit Numbers 6102
4 Road Name s Tahuya Blacksmith
P.O X Road Humber : 70670
Shelton, 8584 Road Location:
Subject to all terms, conditions and provisions written or printed below
or on any part of this form,
Permission Is Scott, Russell
Hereby Ranted Tot PO BOX 1324
Belfair, WA 98528
731-2652
To Install: SLj�
Locations LOT 117 WOOTEN
Parcel Numbers 22319p-50-00117-
Legal Description: tot )/]
A bond in the amount of $ 25.00 accompanies this permit.
Receipt Number: 15271 Check Number: 700
Contractor :
Address :
City/St/Zips
Phone t 426-
Lic. Number: 8xpiress
Specifications:
Aeoata to be WOVOW to popatty Vm wih 3-dpth of don Stavd. Cdwat to be Andes nt.ootvata or pdyHhywta. -
Aeea w we be staked and flagged M Panafttta for po4opooAon. Cdvert wt by it ar of dMth.
Aeoaea ws bo paimpm tad by*6 oUloo p w fo inot:Mifs". Cdvrt to be nobdamaa of 12-dWn~by 2W kmyth.
Aeew kwuft*n AM be in aaaardrra wMt o"unlr
CemmereMMdd u e accoaa dial ropio STOP 84m,hw"W In owdamrnce to do MUTCD manual,at inrematfon whh couW nrd.
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: 427-9670 ext. 450 or at 1-800-562-5628 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:
19
Dated at Shelton, Washington, this day of 19
Issued by:
Title: