HomeMy WebLinkAboutRIGHT OF WAY PERMIT - M19-00046 - James and JuliAnn Lauitsen - 8806 S 400 W - New SFRRIGHT-OF-WAY USE PERMIT �.
MdtDISON COUNTY ROAD DEPARTMENT
Permit Type: New Construction —1, Maintenance _
The Permit shell not he valld fdrncevafion until, or anleae, the provisions of Idaho Code, Title 55, Chapter n have Geon complied with
PRIOR TO EXCAVATION, IDENTIFY ANY UNDERGROUND UTILITIES SY CALLING A LOCATOR SERVICE: 1-8003424585
tltlltty Type (ch<ee y111o1.PPM
PERMIT #
R.sidenBal Commercial
3� ❑ PHONE
= Est. Start Date: I°�st. Complete Date:' El CABLE
Road Name: [.POWER
OV Size
rn Location: V ❑ GAS
Sight Distance: Pass. ❑ Yes ❑ No ❑ WATER
Public Road Surface. ❑ SEWER
Approach Type: pwatmeet fne requi..r of Levy Highway Technical A=fatanoe Council tLKTACI, Standard APPrwoft Pogcy and maho code ae-1zt.
o Single -Family Residence ❑ Multi -Family Residence - No. of Units:
❑ Agriculturat ❑ Business Type:
Approach Width:. Surface Material: ❑ Asphalt Gravel
.: '°"k lan.'Qf... ir✓orkarrat" 6cati/a.fracconSol.r>;oSt�eaCachc'd?"'; _.::a�.i��- :.
I CERTIFY THAT IAM THE OWNER OR AUTHOAvcn REPRESENTATNE OF THE PROPOSED PROPERTY TO BE SERVEDAND pGHEE TO DD THE WORK
REQUESTED HERON IN ACCORDANCE WITH THE GENERAL REQUIREMENTS PRINTED ON THE REVERSE SIDE, THE
DSPECIAL PROVISIONS AND THE PLANS
E PART OF THIS PERMIT.
Nlarne of Permittee: Applicant (if other
the an owner)
•° a
g ature of tetnllittee /Applicant
City �x� State D Z Date r-,
1� "jJ LV4A... I pis
THEMSUSJETEAM IENIMIMOVE-NAMED
NSAND RFORM THE WORK AS DES RI THIS FORM OR A... PERMISSION IS H9iEeY NTE070
THE ABDVE•NAMED APPL1CpN PERFORM THE WORK AS DESCRIBED.
Z YP.MRARY.PERIM
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co Tentative epprova�su¢ipct to fins! inSpac5on - Approved El' Diry ❑ papa .,
J Date:. laiptratlore - < I .
Z By - - - 'Approved By:
W - r AUthorrted RgpT¢sentative
.4uthor¢ed ,Reprgseirtafiye ' -
a Perm Fee $ .. .. - Nide Oidet .
11 1
O Bond Feel $ CtiecJc ❑ # Mosley Order ❑
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FinalInspection: 3aGsfe0ory' ❑ .Cafe:
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