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<br />:PERMrr:~PPJ.:ICATION <br /> <br />.........,............ <br />::::;;.' ",r::::: <br />..... ..... <br />". .... <br />... .... <br />," ... <br />... -.. <br />. . . . <br />.. ,. <br />". ',' <br />, . r - . <br />. ".. <br />',' ,M' <br />o' .. <br />... p' <br />"" .,.., <br />,..... ....... <br />...... ....... <br />:::::::',. ..;:.::::: <br />.. ~ .. . . .' . . . .. .. <br /> <br />1'.~~~2-:':"=.L~~C0:-:-~--.._'-= - .. - - ...:;. _'_'.. '.:~~~'-= ::. ,"'" _ ----.. -. -.-~T:l.l-~-::.._..- _~__.r~~ -._='F'="--: <br /> <br />',~ ~-~'~.-' .- . <br />__._"~~\:.,~~~i:.,i;.;_....._-~...~--~..,._~_..._~ ~__.~f.~~~ .; <br /> <br />{[)RDlEWAYiP.ERMR'.,A~~l![CAmON <br />~OONs;rRUcn:ON'WI7[HIN ~P.tJBI3C :RIGHtr~OF~WAY <br />:AII information ~ be'filled-In completely <br />.\CiW.of~phyrhills <br />'5335 :SthStreet, 2ephyrhills,R33542 <br />"Telephone .813.780.0000 Fax 813.780.0005 <br /> <br /> <br /> <br />~ <br /> <br />',CONTRACTOR: <br /> <br /> <br />" <br /> <br />~~~, <br /> <br />E-Mail: <br />Fax: <br /> <br />- <br /> <br />ARCHITECT/ENGINEER: <br /> <br />.Name: <br />Address: <br />StateUcense :It: <br /> <br />. Firm Name: <br />City: <br />Phone: <br /> <br />State: <br />Cell: <br /> <br />Zip: <br />Fax: . <br /> <br />Desc:riDtion of Proiect <br /> <br />LENGTH OF DRIVEWAY <br />/d.t.='l.WWTH OF DRIVEWAY <br />~ . EXCAVATION <br />_DEPTH ~UNEARJFEEr <br /> <br />.'CURB.ClIT'REQUIRED <br />_YES _NO- <br /> <br />CULVERTS.NEEDED <br />( )REINFORCED CONCRETE <br />( rCORRUGATED MATERIAL <br />( ) BOX OJLVERT <br />( ) OTHER (EXPLAIN) <br /> <br />::L OF DRIVEWAY <br />RESIDENTIAL DRIVEWAY <br />_COMMERaAL DRrVE)NAY <br />_PUBUC ACCESS DRIVEWAY <br /> <br />CONSTRUCTION MATERIAL <br />_ASPHALT <br />~CONCRETE <br /> <br />HEADWALL REOUIRED" _YES _NO <br /> <br />~,..,.'.'.'.'.....'.."J:..{1~..1,"..'.'.,.,.~"'.."....\....,. <br />~._. ...- .. ."fl. .. .:-: .. ,- _.-: ,..... .. .... '" -. .... <br />.- ...' ".,' <br />. ~ '., <br /> <br />NOTICE TO APPUCANT: If actual work exceeds scope of this desaiption, additional pennits or drawings <br />will be required. <br /> <br />UTILITY LOCATIONS REOUIRED: CALL BEFORE YOU DIG: 1.800.432.4770 <br /> <br />Page 1 of 3 <br /> <br />~--- <br />