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MIAN RIVER COUNTY <br /> RIGHT-OF -WAY REVIEW/PERMIT APPLICATION <br /> DATE ROW PERMIT NO , <br /> APPLICANT Mr. Jesse Roland 772-633-9282 <br /> NAME PHONE <br /> 7760 92nd Court; Sebastian, FL 32958 <br /> ADDRESS <br /> CONTRACTOR TBD <br /> NAME EMERGENCY PHONE <br /> ADDRESS OFFICE PHONE <br /> LOCATION OF WORK 92nd Court <br /> STREET ADDRESS <br /> 31 = 38-34-00008-0100-00005 .0 & 0020-00013 . 0 <br /> LOT BLOCK SUBDIVISION UNIT <br /> DESCRIPTION OF WORK : Installation of approx. 315 LF of 6" water main & 500 LF <br /> of ( 2) 11 / 2" water service lines in the 92nd Court westside ROW. <br /> TYPE OF RIGHT-OF-WAY: (CIRCLE ONE) RESIDENTIAL COMMERCIAL <br /> LAND DEVELOPMENT SITE PLAN UTILITY <br /> JURISDICTION : (CIRCLE ONE) PUBLIC PRIVATE <br /> TYPE C STORMWATER REVIEW: (CIRCLE ONE) YES NO <br /> CONSTRUCTION TYPE <br /> DRIVEWAY CABLE TV UNDERGROUND <br /> STREET PAVING ELECTRICITY OVERHEAD <br /> SIDEWALKS/CURBS TELEPHONE STORM DRAINAGE <br /> X RIGHT-OF-WAY X WATER SYSTEMS CLEARING <br /> SANITARY SEWER OTHER <br /> WORK START DATE : July 2012 WORK FINISH DATE September 2012 <br /> NOTE : 1 . Detailed drawings shall be submitted with each application . <br /> 2 . The permit is issued subject to all conditions on reverse side of this application . <br /> 3. A signature by the contractor shall be construed as making the contract personally liable for all <br /> permit conditions unless contractor attached written proof of authorization to act on behalf of the <br /> applicant. <br /> 4 . All work is subject to final inspection by the Engineering Division . Call 772-770-5455 , "AIRS" <br /> (automated inspection request system) schedule inspections for any permit issued after January <br /> 1 , 2003 . <br /> Mr. Jesse Roland <br /> A ANT/ ONTR CTOR SIG AT NAME ( PLEASE PRINT) <br /> OFFICE USE ONLY <br /> PERMIT FEE: NOTES : <br /> ISSUING OFFICER <br /> DATEISSUED <br /> EXPIRATION DATE <br />