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RAP70390 - RAP Permit / Conditions - 1/18/1994
Road No: J 0 3 0 0 0r� S/I Road Name: � � MASON COUNTY ROAD DEPARTMENT 411 North Fifth Shelton, WA 98584 PERMIT Subject to all terms, conditions and provisions written or printed below or on any part of this form, PERMISSION IS HEREBY GRANTED TO: � ��) a-C�,�►'��� ©I� G Address: /�� �� i�5 0 6L%, V#Phone 27�5 4157_3 To install a � C v)V EgA 091 -GR r Location: -r a7?'o CAid'lq c � 1X Legal 'Description: ,04 \50, 1AJ 9,0tv 0R1V1N ) �� Gh Vo 1 9 o f C I a 9,r-c-op, cf_�rl i s Jv Co Ufvy • 11 . 1 REMARKS: Q d P'"l+ I Culvert Specifications: Culvert to be metal, concrete or polyethylene. Culvert to be minimum of 12" diameter by 20' length. Culvert will lay in line of ditch. Access to be graveled to property line with 3" of clean gravel. A Bond in the amou t of $ accompanies this permit. (Rct. # Check # . ) Contractor: � . 1tJ Address:�� �`3J � ash°R►rt ��� 19Ct� Phone. S�i,:7 License No: Expires: / —r ore * Access will be staked and flagged by Permittee for pre-inspection. * Access will be pre-inspected by this office prior to installation. * Access installation shall be in accordance with county specifications. * Commercial/multi use access shall require STOP sign, installed in conformance to the MUTCD manual, at intersection with county road. No work shall be done under this permit until the party or parties to whom it is granted shall have communicated with, and received instructions from the Road Supervisor , Phone: 427-9670 extension 450. This permit shall be void unless the work herein contemplated shall have been completed on or before 19 DATED at Shelton, Washington, this day of 19 Issued by: Title: