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ACCESS PERMIT
Mason Count Road Department Permit Number: 3016
411 North Fif h Road Name : Peg Leg Court
P.O. BOX 185 Road Number : 89160
Shelton, WA 98584 Road Location:
Subject to all terms, conditions and provisions written or printed below
or on any part of this form,
Permission Is Bob Soltis
Hereby Granted To: P. 0. Box 767
Belfair, WA 98528
275-3997
To Install: single family access
Location: NE 30 Peg Leg Court - will be staked and flagged.
Parcel Number:
Legal Description: Beards Cove Division 4, Lot 26
A bond in the amount of $ 25 . 00 accompanies this permit .
Receipt Number: 13183 Check Number: 4834
Contractor
Address
City/St/Zip:
Phone : 426-
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 line of ditch.
Access will be pre-inspected by this office prior to installation. Culvert to be minimum of 12"diameter by 20' length.
Access installation shall be in accordance with county specifications.
Commercial/Multi use access shall require STOP Signs, installed in conformance to the MUTCD 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 : 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: