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. <br /> � � 3—� ������ <br /> '�,a .�,� <br /> � 4t' _. <br /> }2 .na., �rFf, <br /> PERMIT APPLICATION � �`"��� <br /> DRIVEWAY PERMIT APPLICATION <br /> CONSTRUCTION WITHIN PUBLI� RiG�IT-OF-WAY <br /> All information must be filled-in completely � <br /> City of Zephyrhilis ,2'�'l�,r��� <br /> 5335 8�'Street,"Zephyrhilis, FL 33542 � � I <br /> Telephone 813.780.0000 Fax 813.780.0005 �' <br /> , . .., , . ..�. . _ <br /> Dateofapplication: �22= Processed;By:?,>' � �� - Permit:#: <br /> " '(s�ai'a, :r«�ir�±r�' ' � ' � f63�J� <br /> . ._.�, ;�,..:,,.,,;: <br /> %�AY.�guiltling Depeitrrient-.: � `- - •�CARY to-PUbI�Works. . , <br /> PRO�EC7' 706 SITE: PROPERTtf OWNER <br />' Address:38039 Old 5th Avenue Name:.OId.5th Investments,LLC <br /> Unit#: N/A Address: �a5 Green Pond Road Unit: <br /> Parcel Identification Number: 11-26-21-0010-15900-0060 Ci State Z Polk City,FL 33868 <br /> Phone: 863-430-3641 Fax: N!A <br /> CONTitACTOR: <br /> Companv <br /> Name: <br /> Cantractor's License.#: E-Mail:. <br /> Phone: Cell:. Fax: <br /> ARCHITECT/ENGINEER: <br /> Name: Craip L. Cornelison,P.E. Firm Name:. Comelison Enuineerin4&Desiqn,lnc. <br /> Address: 38039 Old 5th Avenue City:Zephyrhills State: FL Zip: 33542 <br /> State License#: 55433 Phone: 8.13-788-7835 Cell: Fax: 813-788-Z062 <br />' Descria#ion of Proiect <br /> � <br /> 30. <br /> TYPE OF DRiVEWAY LENGTH OF oruvEwAY_ Existing CULVERTS NEEDED <br /> RES]DENTIAL DRIVEWAY 3_�WIDTH OF DRNEWAY EXISt111g { )REINFORCED CONCRETE <br /> X COMMERCIAL DRIVEWAY a•°•w• EXCAVATION O CORRUGATED MATERIAL <br />' PUBLIC ACCESS DRNEWAY 60� OEPTH 3�� CINEAR FEEf { )BOX CULVERT <br /> {X)OTHER(EXPLAIN)N/A <br /> CONSTRUCT�ON MATERIAL �URB CUT REOUIRED . <br /> ASPHALT v�s �rdo Existing <br /> �coNCr�re <br /> 11EADWAL�REOUIRED? YE5 �_NO <br /> NATICE TO APPL.ICANT: If actual work exceeds scope of this description,additional permits or drawings <br /> will be required. <br /> UTILITY LOCATIONS R�OUIRED: CALL BEFORf YOU DIG: 1.800.432.4770 <br /> Page 1 of 3 <br />