12902 SW WALNUT ST C.i4(1 c`,' t gyp^
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WASHINGTON COUNTY AI
Fee: $333.(Pd ) Permit No.: (773z-71
DEPARTMENT OF LAND USE AND TRANSPORTATION
LAND DEVELOPMENT SERVICES DIVISION ECP from USA N/A Date: J - `` '
155 NORTH FIRST AVENUE c�/1(/MJF/ I � �
HILLSBORO,OREGON 97124 648-8761
Inspection Option: k/a Co
CIUTYPERMIT
APPLICANT
Application and Permit to occupy Name: t �
,aN Chest, 10411S
or perform operations within
the right-of-way of County
Address: 12-702 5W We iY'ict-1 SI .
and dedicated roads. _
I Mrd , Cr 14zz3
Note: This IS NOT a Utility Permit.
Phone: 41031-t- (3l
--1
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: ,___1(-00)- 14 j)ri dG t,,()1(
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.J
ddress of work:)..2---$91.--- i \AI In(A4 5-,
roject name: LFw i,, v?- (t—Af 011..irA
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 (s-iry-in any , r
w��
Contact Wayne Selander (693-4460) prior toiwork on project, h -1kle --ciiowwcn Ir-o- ' v =
4I ` (n-'nl r ioA 11LV}� .r�
This permit is issued by the Department of Land Use and Transportation subject to the terms and
provisions contained herein and/or attached hereto. This permit is accepted and approved subject to
said terms and provisions.
Improvement cost: 'S �(a(o
Applicant -/��1�(� �'� f C',1/J
By
1. ssurance amount: 5 I�)(o(r,"ry Title
eceived: 2.-2_ i`iio ' r- , 19 S9 Washington County separtment of Land Use
and Transpor !-_-_-1-7---
Expires: I -fi n,h , 1993 B�} �1, / _. -- _'
6/91 -rill