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RULE 14-86.004, FAC. STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 850.040-06 <br />DRAINAGE CONNECTION PERMIT ROADWAY DESIGN <br />,oras <br />Page 2 of 8 <br />PART 1 — Permit Information Sheet <br />Select one: 0 Permit ❑ Exception <br />Pursuant to 14-86.002(2), F.A.C. "Applicant means the owner of the adjacent property or the owner's authorized <br />representative." <br />Applicant <br />Select one: ❑ Property Owner Q Owner's Representative (Complete Part 4) <br />Name: JESSICA HAWKINS <br />Title and company: Permit Coordinator, MBV ENGINEERING, INC. <br />Address: 1835 20th Street <br />City: Vero Beach State: Florida zip: 32960 <br />Telephone; (772) 569-0035 ext. 102_ Fax: <br />Property Owner (If not applicant) <br />Name: Matthew Mitts <br />Email: jessicah@mbveng.com <br />Title and company: City Engineer, City of Vero Beach <br />Address: 1053 20th Place <br />city: Vero Beach state: Florida zip: 32960 <br />Telephone: (772) 978-4870 ext FAX: <br />Applicants Licensed Professional <br />Name: Aaron Bowles, P.E. <br />Email: mmitts@covb.org <br />Florida License Number. 55313 <br />Title and Company: Vice President, MBV Engineering, Inc. <br />Address: 1835 20th Street <br />city: Vero Beach <br />Telephone: (772) 569-0035 ext. FAX: <br />state: Florida <br />zip: 32960 <br />Email: aaronb@mbveng.com <br />Project Information: <br />Project Name: City of Vero Bch RNV improvements <br />Location: SR60 Vero Beach <br />STREET SR. NO. US HWY NO. CITY <br />Indian River 33 39 <br />COUNTY SECTION(S) TOWNSHIP(S) RANGE(S) <br />*Geographic Coordinates: Latitude (DMS.SSS): 27.638879 Longitude (DMS.SSS): 80.429486 <br />Horizontal Datum: (NAD 83 / Adj.) <br />* State Plane Coordinates: Northing Easting: 0 <br />Projection Zone: ❑ Florida North ❑ Florida East ❑ Florida West <br />Coordinate shall be the center of the driveway intersection with FDOT R/W, or, if there is no driveway connectio , Approved <br />near the center o the <br />property line nearest the state highway. I"'^yp rove {� <br />*Check with the FDOT Office for requirement. 2 01 8 , — — 0 0 <br />5/1112018 <br />