HomeMy WebLinkAboutRAP94-00046 - RAP Permit / Conditions - 10/20/1994 Road No:
LI Road Name:
is MASON COUNTY ROAD DEPARTMENT
411 North Fift
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Shelton WA 98584 A� v r1
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PERMIT
Subject to all terms, conditions and provisions written or printed below or on
any part of this form, M
PERMISSION IS HEREBY GRANTED TO: I �°`��-+n "`�`� � '15�'�'�' �`` C_
Address: Rl'�' , (�)o� Sig (3e(- �r �t �S�3 Phone: Q >>
To install a 5-1 -4S
Location: r
Legal Description: u:A- a—
REMARKS:
Culvert Specifications: Culvert to be metal, concrete or polyethylene.
Culvert to be minirwm of 12" diametar by 20' length.
Culvert wil lay in L* of ditch.
Access to be graveled to property ine with 3' of clean gravel.
A Bond in the amount of $ N P" accompanies this permit.
(Rct. # Check # .)
Contractor: ct)-- 11c-Address:
Phone: 6 t t License No: iu�ct-c c 18 6C->"T-2 Expires:
* 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 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:
CONTACT OFFICE WHEN ACCESS
IS COMPLETE FOR FINAL INSPECTION Title: