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<br /> ' TOWN OF VIENNA DRIVEWAY AND/OR CULVERT PERMIT (Part 1 of 2)
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<br /> Property Owner: t7A'1`-) IC el(--)5E11--C i'l Requested by:
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<br /> Date of Request: Ac'ei)--I(.-- 74k 20C-)"c'--, Parcel Number: 0909 - e.9 Z
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<br /> Proposed Driveway Location: 401- 1 ...1::- c:.5,-/: X' t 2...4-4 -C. —7 / 5I-:7-6:- AT i k-_ f-{'C:r:,
<br /> Intended Use: Ac 6-5 ) Te_.5 V.?..i:...1._-5.-;-2._- 7,.);_::::-. 1--=,-1.• Arc-- :.-f e.) tvl ia--
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<br /> Stopping Site Distance Available: 6•-"-- (---ic) t\-\, ,-4-`, /,'I --?. 7 5- L-,.-,,_-, T frt
<br /> Posted Speed Limit: 1,C. _ Stopping Site Distance Required at Posted Speed Limit:
<br /> Remarks:
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<br /> Drainage Consideration:
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<br /> Fee ____
<br /> on.Amount: - Paid
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<br /> • __ y/iy. 6 20
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<br /> NOTE: Stopping site distance for driveways is measured with an eye height of 3.5 feet above
<br /> the pavement and an object height of 0.5 feet above shoulder elevation. See Figure 1 attached
<br /> hereto and made a part hereof.
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<br /> i (5,.:.)... , as owner/agent of the above property. agree to the
<br /> preceding terms, conditions,specifications, and have paid the appropriate fee.
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<br /> Dated this /V day of_ 4 .4, , 20 te.
<br /> (Signature)
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<br /> Date filed: ;;// '70,:';? Issued by: t___.-9; %,----,— Date: ,1/7/171/ I
<br /> Circle one:CT.-Icert Needgi Culvert Not Need-.•
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<br /> Inspected by i.---- -,.... . 7,,,,, Date: /(.
<br /> ____a 6 e.:) No.
<br /> DATE_ ' -----1
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<br /> RECEWED FROM_ - — ... ..... . ____ —
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<br /> ,/zaizeze- ot - ' ______ DOLLARS
<br /> )FOR I;F:Nrr.,i/i .
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<br /> -- h, 'AI OF0Fi_____ .‘ . — -.. - -.‘;')--11.c.sq j ---'
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<br /> ACCOUNT. 1 - 0 .'
<br /> CASH 'I --%_,-- 6
<br /> f1 i FROM - —:c--- •••
<br /> ' : I I PAVIA IN-f- . °CHECK ...-•
<br /> DUI, rm MONEY a scims
<br /> 1 1 82
<br /> ,..._.)ORDER 'F Eq-----X"144---" '`•';',-' --- ---eiZit--
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