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<br />/ [./:'/0/7 /b.l!- <br /> <br />> , <br /> <br />;: <br /> <br />...' <br /> <br />ST "Tr or 1l.."Ml^ DEPM fMm.IT OF' TlI.ANSl'OR T ^ nON <br />mUVEWA Y CONNECTION PERMIT <br />FOR ALL CATEGORIES <br /> <br />fORM ISO.O'C.II <br />'YH1lM' rl~ <br />1'''3 <br />r,.. I .0 <br /> <br /> ..:- . .':'.'...;" q-, '.f ',;. ',!;i\i)f(,:- PARTliJ'ERMIT iNFoRMATJON - <br /> I:. .~ - - <br /> , q <br />APPI.ICA T10~ ~"UMBER: C;/- _4 79 R-c}tJ27 <br />Pemllt Cat::llory: ~ - Aceess CIII!~ifjc.tion: .3 <br />PROJECT: ----=-----.-- <br />PERMITTEE: CORlt.EIf\ hrt\\1 REVoCAl1>u::. T~,- <br /> 30\ N oR:rlt <br />C;~el""'lU;kJ'o~__ . /4p!iO ...=L)2p s: ..e T Stale Road: . I 11 LA.,. ~, <br /> "\ <br /> Sial. Road <br /> Stale Road. -- <br />~. "ART 1: PERMITTEE ~FORMATION <br />Penninee Name. ~RR EtlLl}&.~. fZEVoc..A~l~ \1L~, <br /> - <br /> <br />"'=;." ....;,;", ^"'m l, 71-\ I'l Q..~~ LN<t: t>F. \ "E <br />City.Slale.l.ip: Z.i:.PU.i(l\\\~ fL-, 3351\ <br />lelcPhon":.L~\~ I' S" - 75g~ <br /> <br />Enginccr!Consultanl!or Projeet Man3~er.:i.. f L-. ~~\~~~\ Nbl II'( L.. . <br />En~!ne~,::~siblc for eonitruclion inspection: ~ r-\ K. ~N- TE(2..... 1-1. ~ '5 L <br />Mnilinll Address: _ \ 4 <=t \ ~ ~N ~'1 p\ NE _PL/\ Q.j;i- H. , <br /> <br />lCi'Y'Slale.z,p:~ <br />TelePh()r~_ ( I <i?\; llo 4- - 7 "" 5 0 Mobile o~hone. 1 ~\~) 9_ C> g - :6"3 *1 ~ <br />_ I(,IRC'~ <br /> <br />. H''''''.. ,..i'->:!:(, PARt3: PERMrfAPPROVAL'f;,.::<:-g~:~/':'J: <br /> <br />The .bo....e application hIlS ~q reviewed and ;s herrby appro~d IJUbjrello all Provisions u attached <br /> <br />O//J-79J-CkJ27 BY Ch~- 6~ <br /> <br />Department or TranspO!1alion ar. G. Boone, .P.E. <br /> <br />/ .Jl zi -0"2-- TrrLE: Area Maintenance Engineer- <br />(:l...., <br />fl-2c1-tJ L <br /> <br />.'..t . <br /> <br />i FERJ\OT to.'UMBER: <br />I <br />I Conslruc!ie>n shan beLlin br: <br /> <br />and sholl be cOlnplcled no Isler 1"00' <br /> <br />1t>o1" <br /> <br />Dlle cflssuAlnce, _ ~l -'2-+-e:> \ <br /> <br />Special provisicns .ttached <br /> <br />YES <br /> <br />~ NO <br /> <br />o <br /> <br />NOTE: fh;$ pemlil is onlv ".Iid (Of ene cllendar year from dale of issuance. <br /> <br />Recomnended for Approv.1 by: _~lJ:tAN ~PADENKO <br /> <br />'/ 2-'-I.-r I <br /> <br />.~..; . <br /> <br />~~-- - <br /> <br />/0...) <br /> <br />~ <br /> <br />NOTE:8EEAlTACHED SHEET FOR <br />~ SPECIAL REQUIREMENTS <br /> <br />THE BROOKSVlllE MAINTENANCE <br />OFFICE SHAll BE NOTIFIED 48 HOUrS <br />IN ADVANCE OF STARTING WORK. <br />PH: (352) 797-5700 <br /> <br />\, <br />