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� <br /> COUNTY ROAD Snohomish Countv <br /> RIGHT-OF-WAY USE UTILITY PERMIT APPLICATION Planning and Development Services <br /> A7�S 604 <br /> 3000 Rockefeller Avenue <br /> Everett,WA 98207 <br /> (425)388-3385 <br /> UtilityName C/�� ��v¢re7f Date �'� ���� <br /> Mailing Address .3200- C¢o�4 r .s7�: Cily,�✓¢�� �tj Zip 82�� <br /> ��lactPerson l�/r'� B� 'OokS PhoneNo. 72S ^ZS7�g�S <br /> Sec. .3G Township Z� f'ange S Utility Work Order No. <br /> Job Location �(� \�(o ST S.�G. E c.�ER%c'kk- /�� � <br /> Projecl Name and Counly Trecking No.( i � � �1 <br /> SCC 24.10.030(c) Utilities a�.�lyfng for a maJor utility eonstruction permit shall propose erosion and sodimentation <br /> control best management practicos(BMP's)for the utflity constructlon at tho time of application. <br /> RIGHT-OF-WAY US� PERMIT !S REQUESTED FOR THE FOLLOWING: <br /> Description of Use: <br /> Ins�sLC % 4L� LF oF 8 " pvG S��c�ar ctnd 3 SideSewe ✓` <br /> Connecfiions ct.� +`�' - l� }�LL .3 wrey4zr .$�tviGJ <br /> on siCve,� �� See ah�4el�eo� /xan) <br /> UTILITY PROVIDES INFORMATION BELOW (IF APPLICABLE) COUNTV USE ONLY <br /> APPUCl�TION FEE <br /> PERMIT FEE <br /> ROAD SHOULDER CUT _L.F. uNEn�FEeT x.35 <br /> ROAD P �PHALT/CONC CUT /80 L.F. LINEAL FEET X 1.00 <br /> PLOWED CABL[ IN ROAD L.F. LINEAL FFF.T X <br /> ESA _Yes �_No TOTAL: <br /> yes no <br /> ❑ Q( Is the proposed construclion located within a critical area as defined by <br /> SCC]2.10 requirinB�Title 17 Brading permit and SEPA.SCC77.05.020,17.05.040. <br /> ❑ � Is tlie proposed construction oulside Ihe impervious•oad surtace over 200 square feet and less than 5,000 square teet <br /> requirinp a Title 24 Wrgeted drainage plan. SCC 24.10.070,24.20.C�`,2470.080,24.70.175 <br /> ❑ �( Is the proposed construction over 5,000 square feet outside the Im,.arvious road suAace. SCC 24.20.025. <br /> NO WORK OR ACTIVITY SHALL BE STA�ZTED WITHIN THE PUBLIC <br /> RIGHT-OF-WAY UNTIL A PERMIT HAS BEEN GRANTED BY SNOHOMISH COUNTY. <br /> I will accept a permit subject to the lerms and conditions of Title 13 as herein set forth. <br /> �It �t�I�IZ- �� �� <br /> Sic�nature ate <br /> ------------------------------------------------�----------------------•-•-------•-------._.....---------....---�•---------•--••-•-- <br /> COUNTY USE ONLY <br /> TRACKING NO. INSPECTOR <br /> SI:tC:.P�LIILAPPL :':IIR[COP1'�POS CANARI'COP\'�IflSnfGiION PIIIKCOPV�FPP�I�ANTUPONPEFI.�ITFPPRO'dFl <br /> �:-t0?J ,,. <br />