HomeMy WebLinkAboutRAP9791 - RAP Permit / Conditions - 2/9/2004 _ PERMIT
M o Col >rj/ o d Department Permit Number: 9791
Ort If
tRoad Name Collins Place
OX � Road Number : 77060
fi lOilt WA 84 Road Location:
Subject to all terms, conditions and provisions written or printed below
or on any part of this form,
Permission Is Al Ortiz j
Hereby Granted To: P.O. Box 246
Tahuya, WA 98588
275-4682
To Install: single family access
Location: 181 NE Collins Place. Collins Lake Drive take 2nd Left onto Collins
Place . Left side of cul-da-sac (going into cul-da-sac)
Parcel Number: 22331-52-00047-
Legal Description: Range 2, T 23 , S 31
A bond in the amount of $ N/A accompanies this permit .
Receipt Number: Check Number:
Contractor : A & A Concrete
Address : P.O. Box 246
City/St/Zip: Tahuya, WA 98588
Phone : 275-4682
Lic. Number: aaconc*077b Expires: 01/22/06
Specifications:
Access to be graveled to property line with 3" depth of clean 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 30' 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 : 360-427-9670 ext . 450 .
RESULTS OF SITE INSPECTION: See Attachment "All
This permit shall be void and bond forfeited to Mason County unless the
work he cont plated sh 1 e been completed on or before:
Dated at Sh 1 on, Washington, this day of OA
Issued by:
Title :
PERMIT
ATTACHMENT "A"
Permit Number: 9791
Type of Permit: District . 2
single family access Rd Number: 77060
Road Name: Collins Place
Permittee: Location :
Al Ortiz Date 02/02/04
Parcel Number: 22331-52-00047-
SITE PRE-INSPECTION
Site Distance Left Okay Right Okay
Culvert Required: No
Comments: Install as per County Specifications.
Date: 02/09/04 By: David Clevenger; (Inspector)
PROPERTY OWNER NOTIFICATION
Property owner notified of results of site inspection and permit issued by
Engineer's Office on this date: 02/09/04. Access may now be installed.
Comments:
NOTIFICATION OF COMPLETION
After access has been completed, property owner shall contact the Engineers Office
for Final Site Inspection (Phone: 360-427-9670 Ext. 450) .
FINAL INSPECTION:
Comments:
Date: By: (Inspector)