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<br />Feb 10 2006 7:03AM <br /> <br />HP LASERJET FAX <br /> <br />~ <br />. <br /> <br />ACCESS TO COUNTY HIGHWAY <br />PERMIT APPLICATION <br />SberbUl'De County Publle Works <br />7&Z41-'7000 <br /> <br />p.s <br /> <br />l- Permit No.: 06 .11 · 051 <br /> <br /> <br />In: <br />HiPway HQ:~ <br /> <br />SectiOD..!i... Tow_liD. ~ ~ Range '.zJL <br /> <br />AD .~ wIIItba an Uadtecl by MDDOT SiaDcIIInl Plate No. ,GOOD <br /> <br />CJ Roaidtmtial AccMa &hall be IS' miDimum to 24' maxhnum PIN: <br /> <br />)a "~t,lPdu~ ~qjtiq..Acec".i;':;,.~ '~~'.' j:tewl~N~;. <br /> <br />D Public, SU'Mta are an a cue by case ball. StrecIt Nama: <br /> <br />L we. the WIderIiped., hen:with ID8b appJicatioo to COIlItruCl 8ft .x:e&I onto a County Hi,hWlY and tblIt IIIIid ECe8I ,ball be <br />COIl~ to meet the ~ standarda ad c:uaditiolll of Sherbuma County. TIle 1Ipplic:1IIt IbaU comply with aU ...-.ble ruleI <br />8J1d ~adODl aDd ordiltm:oJ in cffilQ lit the lime of iUwmclc. CoIl8'lnM:ti~D of tho ICe" ,h81l DOl be &tIIIDd _dJ dMI appJlcadOll it <br />apptOvcd. and. the permit iuued. In the event tbat 1bc COIUItruC1iOD has Dot beea fully ~ by the expiration cIate, the permit <br />becomes DUO and voJd ucl!be Aeocu BoDCI fee Iba11 nor be mumed. 'DIe _....tIII. !In IIaed - .... back 01..... ......'IIIIIl_ <br />added pro........ MIMI.'_ID - ...~~ .....~'~ ~ penal.. <br /> <br />DIte: IIJ1IfJ{,. S......etA~--c:I)~~~. ' <br /> <br /> <br />DEPARt'MENTtJSE ONL Ys <br />sso.oo PrIvate <br /> <br />_r-ot".....,..-..w~#JwM:~ww..:...:.. ". <br />,.~'tf,JIIt.. . ~"'':~'~'''''''' <br />sll" $100.00 o-.-~ ,)' <br />'~~-:.~..~.- .::.;.~'" .::;;"~"'1~~;.~.:-::. :~~ <br /> <br /> <br />1JIIpcc1i0ll"Datc: \ \ 'I- t, <br />ofW W'1dth tromceatediDe: <br />O:dvcrt~ 0 Ya ~ ND <br /> <br />Diameter & lAJiJtb: <br />Price Uneal Foot: <br />pel' " <br /> <br />Number ofBIDCIa R.CqlDrcd: <br /> <br /> <br />sa AppI'IJWd <br /> <br />Cl DeDled <br />Siped: <br /> <br /> <br />~ ; 1I1r"~ "~~ *~ <br />~.....-.", .I <br /> <br />:uk. <br /> <br />FlnallDJpectIoa: <br /> <br />n... <br /> <br />PriwUe Permit Pee Paid: <br />Ac:eca BOIIcI Pee Paid: <br />MaIlbox Support Paid: <br />" TOTAId <br />Date Ie Ck 41: I <br />OllWll't 0Jily: <br />B~ .t: AprontI_: <br />DeIi.w:ry Charae: <br />S" Tu: <br /> <br />D&te II: ct *= <br /> <br />TOTAL: <br />'J <br /> <br />-.. ..: <br /> <br /> <br />!>--.cW Permit Fee PakI: S 1M I \j) <br />Acccu Bond Fee Paid: S~ <br />Stop Sip: 0 ! tS8O, <br />Addltlooal Sips: II! <br />. $100.00 ech.: J-A <br />T :AL: 1J.t7 $ &WI> J1l;1 <br />Dale II: ct It: :.G1l3 <br /> <br /> <br />BOND PBB RBTVRNBD: <br />Dt\TB: <br /> <br />S1GNA~ RBTURN TRIA PORM AJTER. "".1. WORK IS COMPLETED <br /> <br />o <br /> <br />RIlbIm to: S........ Couaty Public Worb <br />AItD: 1luI BeIUDI <br />42$ JaeboD A........ <br />Elk Rlver,)Of SS330 <br /> <br />Date Access Compleaed.: <br /> <br />Applicant <br />Sisnatun:: <br /> <br />. <br /> <br />.' . .. <br />