HomeMy WebLinkAboutRAP9717 - RAP Permit / Conditions - 6/1/2004 PERMrr T�,,Ja
M son Road Department-., Permit Xumber:
P O' BOx Road Name = T ev,Lo-_ P-00 0�
Road.Number : g Its `
S�eiton, 8684 Road Locations
Subject to all terms, conditions and provisions written or printed bel w
or on any part of this form,
Permission Is Y)e�r i 1J�f 1
Hereby Granted To. 4
C- NY�
To Install: SteP -eh V o VA v,
Location: -
lot ticT L�Ke- �d lcJ
Parcel Number=
Legal Description:
A bond in the amount of $ accompanies this permit.
Receipt Number: Check Number:
Contractor = t' e k4Q' 36LA-,S o Y+ SN C,
Address = �
City/St/Zip: DeIf.4-I� C! gaszPj
Phone : 36o Z-AY 67 3
Lie. Number: L-j Expires: r A
bbeaif ications= -
Access to be praveW to property line with s-dope,of der,eravd. Cdvert to bs abnaia M.concrete or polyethylene.
Access will be ateiud and nagged by Porn""for pr*-Inapoodoc- Q/ssrt wr ball in Yne of ditch.
Accees will be pre-k.pecba by thin office wor+o Motion- cdwrt to be..iaawrn of 12-_diameter by 20'k nwd,.
Aooaes instatetlon shelf be in accordance with county speoifl—tionr.
Com merolal/Multi we access shalt require STOP iigne.instaMd in conformance to the MUTCO maaaL at intrsectfon whh 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 aAa
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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