Loading...
2015-21 ROW Permit 09292015 1' " City of Yelm Permit No.Zo l '�� PUBLIC WORKS 901 Rhoton Rd NW Application to Perform Work on Yelm,WA 98597 Public Right of Way and/or Connect Phone: 360-458-8406 to Utilities FAX: 360-458-8417 APPLICATION The undersigned hereby makes application to. 1, -_. _4t i + � rw ter,. I!1 w L'V-) l �.w ... ' Location of work: I a ree to erform the work-in strict compliance with Yelm Municipal Code, Chapter the special conditions enumerated herein and the attached conditions I have read and will adhere to the genet-at provisions applicable to_permits contained on this form. The Public Works Department(360-458-8406) must be contacted for inspection 24 hours before work commences or this permit will be void. _ The Underground Utilities Coordinating Council(1-800-424-5555) must be contacted two(2)working days Name:--., associated with this permit. t before t o eedin with an e xca. ._____ ...�w..._.-._...�.w. �_–. Address: � ._ , �Z lcib ' Phone: „.~... Proposed starting date of installation: 11 Ot f Duration: ,2 a�..... .._. I_ U... Signature: _. LG�"_....-....._ _....... .�-.... ... ._...- Date: (S g Pri,.R II IAL I.IIREME $T For Off acial 1 °'e Dn Issue Fee .w W. . • m. _._.. ............._ _ Fee Received A pp li�atirt pp t ...w Receipt Number ... cccr t Num e Signature: .. _. To Be Coi .leted By CJ Permission is hereby granted to perform the above described work subject to the general provisions contained on this form,and the following special conditions; A bond in the amount of is rewired to insure compliance with the above conditions,refundable upon satisfactor completion of work, No work shall be done under this permit until the party or parties to whom it is granted shall have communicated with and received instructions fiom: Remarks: First Inspection -�� —1 Inspector Final Project---F Date: Date Completion A roval: Revised 03/09/2011 Job 3 0 1 ,5_2 -3 PRE-INSPECTION REPORT 9`1 MP_ OUNO 1:M:ku V Date: f-23—/5- Address: 16 53 Jurisdiction; ye,144 City/Zip: V-e_1144 Right of Way Permit?' Fj YES ❑ NO Customer: GV$f NX)NE NUMMiR Est. Start Date: PM Insp: Af g7 Est, Duration: PHONE NUMBER WORK DESCRIPTION: V I pC— XN (4c, eo Construction Method 6— Ze Open Trench ET 0 Trenchless ❑ PLAT MAP: UR 2`1 _ew Ab Work Location Size of Cut Surface Type .............7z-C— E W f o C L IN S of CL I &_ 'E W of CL -- ....... ..... IN S of CL ...... 'E W of CL FLAGGERS# 3 MPH ❑ TROLLY LINES ❑ BUS STOP# ❑ METER HOODS# ❑ OFFICERS# SPEED LUT ❑ TRAFFIC SIGNAL ❑ ARTERIAL ❑ NO PARKS# Commercial F-1 Altered Commercial Leak Repair Service Information ❑ Template Bar Residential F1 Altered Residential CP Work Diameter Meter EFV Bollards 2.5"# ❑ Multi-Family ❑ Replacement service F-1 Pothole ❑ 5/8" ❑ 250 ❑ 1800 E) Bollards 4"# F] New Constr. ❑ Main Maintenance ❑ Extension ❑ 11/8" ❑ 425 ❑ 2600 ❑ Stub ❑ service maintenance 11/4" ❑ 630 ❑ 10,000 ❑ FUEL LINE PERMIT NEEDED ❑ Extension ❑ Valve Maintenance ❑ 2" ❑ 1000 Fuel Line Length: Compete Sery F-1 Cut&Cap Mtr Loc. Fuel Line Diameter: N , v � M N J ' M............ . . ............ & fin a a — o a t no / u ✓ Mm lo �" r" �`'���. ^FMS •�^"' .�' �� W N �p, N' xk LU ,w o N 10 CD Lo 16OLO V, ti N O ' S I hw _� N o r 00 i - ' P ��O . --------- ......�.��.����� � � _,. Thurston County Map Out, Sage Page I of I Thurston County Map 104,141 Alto ff................................... N S VAIN JHVIV;aI BEAR 601 S 1141� 0 —376k Disclaimer:Thurston County makes every effort to ensure that[his map is a true and at 'CAJoac refire sentat ion of the wo,l,orcounly,goverioneut.HoNwver,the Comity and all LEGEND rclated persouncl make no warranty,expressed or implied,regarding The accuracy, completeness sw convenica,ce of any iorounation diselosed on this matt.Nor does the C(umtY Major Roads accept liability for arty(bruage or injury causvd by the use of thus map, :111bv Flood Zones To the fullest extent pofaiissibh:pussumst to applicable low, rhuiston County disclaims A Roads warranties,express or implied,including,but not limited to,implied warranties ofnierchruit 1)1116Vii, Water Bodies ability,data fitness for a particular purpose,and non-infringements of proprietary rights. Under no circumstances,including,but not limited to,negligence,shall Thurston County be Streams liable for any direct,indirect,incidental,special or consequential damages that result from Zoning the use of,or the inability to use,Thurston County materials. Contours '11111i's(MV,0 2013-Thmston Courgy GcoData Center Wetlands ........... cities 0"oDouk 929 Lakoldge Drive SW,Suite 216,2nd Floor OT C'eme ( Wetland Buffers Parcels Ayorpht W A 98r)(12-60,3 1 http://www.geodata.org/servlet/com.esri.esrimap.Esrimap?ServiceName—cadastralov&Clie... 8/24/2015 r�Q LD E N OV31,1V o>N a r �ra x _ n ul O Eav r- P9 Q. U)LLJ - 07 a 16 O7 07 N mLo. X wi N N M O W p O N -t u) m C �' M N N N tltl Z d Lu O o (O o h q = w O ''� (D . .__. . w � to _. a__ II t g N EL LO b WWWW loop lo u Z N O^ ^LO 0 m o s II C Z F O N N m0 N ®S® yp ppyy,,pp�ry {{ V Z W N 'M 20-5L ''W^^ V,.oo (D a6-C7UU w� « 0 ZZ _— b cr N Q H N �) J a w p 4 zw � OV ° N ^ � Z U N 2W' oL'o �qxq p�p a , vM dp k u) MN LO I U Nm o g c° � � m Z a aIo o,o w � m . v m � � — Xaov7oo c N a) OD VYM N� L_ a) 'Lo. O 7 O O L m � x E ai 0 C L I N E C E m o � � m.� N m m �� Z + � � o o w m - o o . � " , m`7aou7 C '(RD m QO E ca E u C p p �O v7 co M N O N (7 > N U $ d acOi ami E ami —°7 aci a ui d q U U m 0 U N u) cu m > m C O Y O-'� C m 4 a a 0 3 m Y m m _NU N- L mC d O o Z mcv mriv mL6 .. (or_: o6w 3S 1S N33a� {q ✓ / p i e° /F LL 2 ¢ 0 Lu ul Em