2000-08-01 Dept of Hwys Permit 0035, 0036
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DEPARTMENT OF HIGHWAYS
Wnglu Counry PublIc Wortr BwldUlg
/90/ Hlrit-'llJ ,,*,11
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DRIVEW A Y PERMIT APPLlCA no
PDMrr No J)03s
Jcr r H lJ aNt C R /Ja
r~l~plttM. 16/2) 6!2 7]4] FAX (6/2) 6!2 7]/J
INFOR'rIATION NEEDED PRIOR TO INSPECTION
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Applicant Requests Phone Call Yes Q No 0
~ee Q~Gt.h~ s'nu.\- ~), J /} Y-c !i-'J:!c 1:
Dayume Telephone Number l~\2.) 32'3 - 'to 8 (..
COUNTY HIGHWAY NO 1'0 SPECIFIC LOCATION
Side of road drtveway [0 be Installed on N S E @
(errel, Oil')
SEC ---2-
TWP J2A.. RANGE-ZL
(A'PPIt())I.) /I Ut;I S; :20 00
CONSTRUcr(ON DA 'fE IJ~.II ?_,.,... I \-
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APPLICATION IS HEREBY MADE TO CONSTRUCT AND THEREAFTER MAINTAIN THE FOLLOWING ENTRANCE TYPE
ReSidence 0 Pubhc Street )I{ Farm 0 Field 0 Commercial 0
CENTER OF PROPOSED DRIVEWAY MARKED WITH A LATH? Yes~ No 0
A MAILBOX SUPPORT IS REQUIRED IF MAIL WILL BE DELIVERED TO THIS LOCATION
Mailbox support needed Yes 0 No ~ If yes please complete Maubox Support Apphcanon (attached)
A $25 00 INSPECTION FEE IS DUE AT TIME OF APPLYING FOR PERMIT
(SEE BACKSIDE FOR REQUIREMENTS)
DATE PAID- s>,/ -0 e:> ~
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DEPARTMENT USE ONLY '"*'
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SITE INSPECTION DATE 8'- )-0'0 PRICE OF CULVERT $
RIGHT OF WAY WIDTH 1,5 ft from cemerhnc PRICE OF BANDS $
CULVERT REQUIRED Dla J5?" Length 90 Ft PRICE OF APRONS $
APRONS REQUIRED Yes __ No 0 # OF BANDS o J..</N'~ R. Te> S:-t? pp 1 '1 C. vI Y~r-r
ENTRANCE WIDTH '+'J · B-8 ~- 1/ SUB-TOTAL $
NUMBER OF EXISTING ACCESSES SALES TAX $
RECOMMENDATIONS Ff ~ ~ -"f-~~~i DELIVERY CHARGE ($25) $
~~...~~ ~ 2. p-aJ p~
O~3S-.Joo3
RkQ -0 P1~1 -~ TOTAL $
APPROVED BY -
SPECIAL PROVISIONS ATTACHED Yes lit No I:( DATE PAID VA
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As an appllcant. I understand that thIS pemut WIll expire after ~ year I shall conform to the recommendatIons above and
to the requirements as stated In the Wnght County Dnveway Access Polley on the back of tills form In addltlon I shall
maIntain the entrance and take care nf all era,..n for twn (2) yearA UIStall:On e
APPhcan~nature' ~
Copies [0 jjz( OrlgmallDnveway Permit File I
~pphcant
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o Accountant
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DEPARTMENT OF IDGHWAYS
Wnglu COIUII'J PrlbllC Wonb Bwlduag
/90/ HIP-'! 2S ,Vonh
BII/IbJD WINlCSOf4 SSJ 1 J
DRIVEW A Y PERMIT ApPUCA nol'
PDMrr NO_ Or\.3 <0
Jcr r H 2S IlItd C R IJ&
r~l~pllDM (6121 6&2 7JBJ FA)( (6/21 6&2 7JLJ
INFOR~(A TION NEEDED PRIOR TO INSPECTION
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Daytime Telephone Number
['-\2.) 32"3~ '08(.,
1'0 SPECIFIC LOCATION
Appltcant Requests Phone Call Yes 0 No 0
<;ee Q*GC.h~ S'nu-\- k' Q h I A-y~ S E -::r::.-r
TWP ...l2JL RANGE~
(A1'P4.())I.) 11 /.It &; 'S;.;J.,o 00
CONSTRUCTION DA'fE \)~.n ,-",-.\0
Af,"". ,
APPLICA TION IS HEREBY MADE TO CONSTRUCT AND THEREAFTER MAINTAIN THE FOLLOWING ENTRANCE TYPE
Residence 0 Publtc Street ~ Farm 0 Field 0 Commercial 0
COUNTY HIGHWAY NO
Side of road drtveway to be Installed on N S E @
(C,rcl, Off')
SEC -L
CENTER OF PROPOSED DRIVEWAY MARKED WITH A LATH? Yes~ No 0
A MAILBOX SUPPORT IS REQUIRED IF MAIL WILL BE DELIVERED TO THIS LOCATION
Mailbox support needed Yes 0 No b( If yes please complete Mallbox Support ApphcatlOn (attached)
(SEE BACKSIDE FOR REQUIREMENTS)
DATE PAID- ~, J-I? 1!:> ~
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A $2500 INSPECTION FEE IS DUE AT TIME OF APPLYING FOR PERMIT
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DEPARTMENTUSE ONLY , ,
SITE INSPECTION DATE ~- J- 0 C') PRICE OF CULVERT $
RIGHT OF WAY WIDTH t;..s ft from centerline PRICE OF BANDS $
CULVERT REQUIRED Dla ) 1r'~ Length 90 Ft PRICE OF APRONS $
APRONS REQUIRED Yes J( No 0 # OF BANDS o J..<.:>).J t R 70 sv 1'1> J '9f C!vfy<:,....r
ENTRANCE WIDTH 4lJ · J?-~-? ~ SUB-TOTAL $
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NUMBER OF EXISTING ACCESSES SALES TAX $
RECOMMENDATIONS f;?~ ~ ~ DELIVERY CHARGE ($25) $
a.c<_....~>t:>~~~ ~.y-.- p~ _
<:::) c::> .3 S- 0.0 at;
/>1- # ~ ,. -~ TOTAL $
APPROVED BY R~
SPECIAL PROVISIONS ATTACHED Yes~ No'O DATE PAID N/h
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As an appltcant, I understand that thIS pemut wIll expIre after ~ year I shall conform to the recommendations above and
to the requIrements as stated In the Wnght County Dnveway Access Poltcy on the back of thIs form In add1tlon I shall
10'10"10 the entrance and take care of all erOSlon for two (2) years A mstal!:on e
APPl~natur" .~
Copies to XOngmaIlDnveway Permit FIle I
~pphcant
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o Accountant
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