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STATE: CIO RONDA DEPARTMENTOFTIRM1812CRTATION .8$0440-15 <br />DRIVEWAYICONNECTION APPLICATION SYMM&PLAMING <br />FOR ALL CATEGORIES 0M <br />Page I of 3 <br />AppricaUcin Number Remived By! F= WW (IYPE OR PM" <br />patiagoly. Date: <br />SectiorAffile Post Sate Road: <br />SeGdOI%Vllat Post State Road: <br />Instruc;liops.- To Applicant <br />• Cbntad#* Department of Trqortation to determine what plans and othardocuments you are required to subrrilt Wft your application <br />• Complete this form (some questioris may not apply to you) and attach all necessary documents and suboft it to. the Department of <br />Transportation <br />• For hat with. this form contact your local Maintenance, or District Office <br />• help with . I tact <br />Or Visit our weballe at www dot zt.ate.flus/onestoppermitfing for the contact -person and . phone nwriber Inyour area <br />• You may also email - drive�dot state flus. <br />Or call your District or - l6cW Florida Department of Transportation. 00ice. and ask for Driveway Nrrnfts. <br />JAMICANT:, <br />Check ones <br />0 Owner 0 Lzssee 0 Contract to Rwdiase <br />Name: Indinn Mypr COunfy Pubfir Wn&n <br />Responsible Officer or Person. 'Mr- jamo-'.q eorris, P_F_ <br />if the App eant is a Cotripanyor Organization, Name-.. Indian 'River Couft. <br />ti :1FYI I ME rin <br />city, state:, Vero Beach, FL <br />, 32960 Fftrio- 772-226-1 - 221 Fax 772-778-9391 <br />LAND QWNER'fif'nat apphcard)F <br />Nam: The City of Vero Beach <br />lfftApplicant isaConVmyorOrganization Narrie- The Qty of Vero Beach Public Works <br />A,ddrm: 1053 20th Place <br />City. State: Vero Beach, FL <br />zip. 32960 'FhGw. 772-978-4870 Fox . <br />EYnaie Mmitlg@,c <br />_eOVLM <br />Approved <br />2018-A-490-01 01 <br />.Nesa Harden <br />5/8/2018 <br />