HomeMy WebLinkAboutRAP5013 - RAP Permit / Conditions _ ACCESS PERMIT _
Mason Count Road Department Permit Number: 5013
411 North Fif h Road Name Mason Benson
P.O. Box 185 Road Number : 63010
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 Milt Locke
Hereby Granted To: E 3440 Mason Lake Drive West
Grapeview, WA 98546
426-5568
To Install: multi-use
Location: 1/2 mile down Mason Benson Road from SR 3 . Parcel is adjacent to
Church - see attached map.
Parcel Number: 22110-34-90072-
Legal Description: Lot 2 of SP 875
A bond in the amount of $ 50 . 00 accompanies this permit .
Receipt Number: 14169 Check Number: 3127
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: