12828 SW WALNUT ST CI`Fla C:4 7,7)vet
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Fee: $333 p�,) Permit No.: 9`/3�elli
DEPARTMENT OF LAND USE AND TRANSPORTATION
1 LAND
NOR HEFRSTAVENUE LOPMENT ICES DIVISION HILLSBORO,OREGON 97124
ECP from USA Ni Date: Jen(l �fL.i `1f j lye
648-8761
CI PERMIT Inspection Option: via Co
APPLICANT
Application and Permit to occupy i��raN ��h�j5 �Di�ci;S
or perform operations within Name:
the right-of-way of County Address: lZ 1 JZ Syi/ �n�a lntd I .
and dedicated roads.
kr 0 rd , Cr 1` ZZ3
Note: This IS NOT a Utility Permit.
Phone: (0 ` ISLE }
APPLICATION
Applicant hereby applies to the Washington County Department of Land Use and Transportation
for permission to perform the following operations within the rights-of-way under Washington County's
jurisdiction. Types of operation and location are as follows:
Type of work: `,, �i'dli)- le JJr I 0 u 1( ('
d
dress of work: 'v1-. ,W \?Inu� : rt,
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name: LFw4, I-- .,r
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PERMIT i
The appropriate general provisions contained in Washington County, Department of Land Use and
Transportation, Rules and Regulations for Pole Line, Buried Cable, Pipe Line and Miscellaneous
Operations and/or Facility Permits July, 1970 as supplemented and modified by the attached
standards and the following special provisions, shall apply to this permit, and by this reference, are
made a part hereof. It shall be the obligation of the applicant to obtain said rules and regulations from
the Department of Land Use and Transportation and to determine which of the various provisions are
applicable before commencement of work under this permit.
SPECIAL PROVISIONS /rS D'Il. any r,
Contact Wayne Selander (693-4460) prior footwork on project, w�4k -(he -clew„, In-e*-�a-.t:
+rop, (rJb-rglil~ A0(0 nun1 ,r°
This permit is issued by the Department of Land Use and Transportation to the terms an
d
subject
provisions contained herein and/or attached hereto. This permit is accepted and approved subject to
said terms and provisions.
Improvement cost: 5, ��(o Applicant , �'14L/4l/L�+c(� 1G-1/,j
By
ssurance amount: 4 5)�,6,i,,°7- Title
eceived: 212_ wo 17_r , 19 3?9 Washington County epartment of Land Use
Expires: 3� and Transpo j — J
p ,'/� VA , 19`Th �-,,` ,ram- i
6/91 T
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