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<br />FOR.M 8S0~"O-15 <br />SYSTEMS PLANNING. 11194 <br />PAGE 3 of6 <br /> <br /> <br />IF YOU ARE APPLYING FOR A TEMPORARY, PUBLIC STREET, OR SAFETY <br />UPGRADE PERMIT COMPLETE TIIE FOLLOWING: <br /> <br />CHECK ONE <br /> <br />o Tempol1l1y Permit, Description: <br /> <br />From (DllI"): <br /> <br />To (Dale): <br /> <br />(NOlllO Qceed 6 months) <br /> <br />o <br /> <br />Public SlttCt, Road or FlICilil)'. (Jescrip~ion: <br /> <br />f,"J1ected DailyTmffic <br /> <br />o Safely Upgrndc:. Iks.:riplion: <br /> <br />Property Physical Sill.: Addres~; 0;,1- 4b (};, A-.LL &-'Il> " v... . S. ~D <br />Uctwccn:MJ~ 7-5/7 f'!, l:>F ~~~= IQ~ _I" <br />!;b..:<;"T <;1h.G: oY' !A.5.. '30\ ~C)IL\llt I V AC4\"~, <br /> <br />II ...,..,....... " VI ....-,....- ........ .." IntonNllCllO OIl' ..... __ <br /> <br /> <br />AnACH EXTRA SHEI!TS IF :-lEEOEO <br /> <br />Please indicate North <br /> <br />',-- E.~I~n\\f.- DRW[J~l ~ <br /> <br />):::- ___.~__.-_-_-n ____. __._..._______ <br /> <br /><I ~ ').:''-' 0 ---- ---~-7 <br />L; . (V) <br />'\, ., <br />IV r' "'_. ____ <br />~ --............--- <br /> <br /> <br />"f~ j <br />I(~~ <br /> <br /> <br />. m___________._ _ '\... __________________________ <br /> <br /> <br />IF IT WILL 5i:RVE TO DErrER COMMUNICA-ll::, <br />PLEASE PROVIDE SKETCH Of PROPERTY LOCATION -(SCALE IS NOT IMPORTANT) <br /> <br />L- -~~~.; 0 - c~~~~-~~:AY ANl!CONN.CTION LOCATiONIN'=:::::N~-'-=~=-=--=1 <br />I{ond N:urn:: ~. D' ~~..~, 0 \ Road Nllme: _ <br />Roadw?_, ^coe.'I.~ Mar.OgC~ CIM,ificalion 3 Roodway Accns Manlgeml'nt Classification I <br />- lA".1IIIIt II lJr........ t^....,..., .. ..~J <br />4b <br /> <br />1'05h:O SP.:W Lirnir- <br /> <br />MPH Posted Spel:d Limit: <br /> <br />\ifH <br /> <br />Road Section Number: _ / ~..50 <br />c"...........~) <br />Mile Posl Numlll....: -5: 5(J 0 ~ <br />"',.... . ea.u.:r.1 <br /> <br />Road Section Number: <br /> <br />IA~ .0.,...... <br /> <br />Mile Po!!. Numbo:r: <br /> <br />,Aw_l... . DrIpuwIan, <br /> <br />(AITACH ADDITIONAL SHEET AS NEEDED) <br />CON-rlNUt: ON NIXT 'AGE <br />