HomeMy WebLinkAboutApplication for Utility Construction Permitr'
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NORTH ST. LUCIE RIVER WATER CONTROL -DISTRICT
("District")
2721 South Jenkins Road • Fort Pierce, FL 34981 • (407) 461-5050 • FAX (407) 461-9446
Application For Utility Construction Permit'
-Attach 2 Copies of Detailed Drawings -
A. Applicant Information
Utility Owner: Fort P i erce Ut i 1 f t i es Author i tv
Address: 206 South 6th Street, P.O. Box 3191
Fort Pierce, FL 34948-3191
Authorized Agent: Thomas W. Richards, P.E.
Agent's Title: Director of Operations
Telephone No. (407) 466-1600
B. Project Information (Attach drawing to show details)
Location: Section 5 Township- 36 Range 40 Canal No. 103
Other appropriate description: Tax I D. #3403-502-0193-000/6
3525 West Midway Road
Type of Utility:
Electric Telephone Gas Cable Television
X Other (Specify) Water Service
C. Contruction Schedule
Estimated Commencement Date: 12/15/94
Estimated Completion Date: 12/29/94
D. Special Conditions (For District Use Only)
E. Application Fee and Use Fee: $ 525.00
(Submit fees with this application in accordance with the District's fee schedule.)
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ACKNOWLEDGMENT AND ACCEPTANCE:
I hereby certify that the information show bove is accurate to the best of m knowledge, and that I agree to satisfy all requirements of this Permit, including
"Standard Provisions," and Special Co itions imposed y t trict, r lected by my signature below:
Applicant's Signature l
Applicant's Name (Type or Print) Thomas W. Richards, P.E.
Datc:: 12/7/94
APPLICATION �P.PIr' AMP ERMIT,}SS`
For the North St. Lucie River Water Co trgl Distrigt�, //
Date of Approval _� b r 0,0
Permit Expiration Date
*This Application will become a Pennit if and when approved and signed by an authorized representative of the District.