HomeMy WebLinkAboutRAP4164 - RAP Permit / Conditions - 6/7/1994 _ ACCESS PERMIT
Mason Count Road Department Permit Number: 4164
411 North Fif h Road Name : Olde Lyme
P.O. Box 185 Road Number : 53490 Vl ,
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 Marsha Rodgers
Hereby Granted To: E 110 Evergreen Drive
Shelton, WA 98584
426-0366
To Install: single family access
Location: on the culdesac at the end of road - to the right side - corner
lot . Will be staked and flagged.
Parcel Number: -�21� 9 7 16(t 0 00e-09
Legal Description: Division 5, Lot 69 , Lake Limerick
A bond in the amount of $ 25 , 00 accompanies this permit .
Receipt Number: 13579 Check Number: 10119
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 wOl 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: