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XKXTHF TII.S C€DIYNEIIV <br />DET'ARTIMENT OF PLIBI,TC WORKS <br />.: <br />""' 'iRoad Vacation Application <br />Fee: $+ZOS,OO cVr{,ck+ l}\+ <br />?srftv*s llD- D'\ -oocc \ <br />Applicant / Desiqnated Aqent <br />Name 5u:l- gc*so t -5e tr, - ? Lg@|,'lncns,( a,lt41 <br />Address 3o t rhreL 1-"-KeS frb Lte- Etw.^ iJcr, <br />Phone Number qL,*sot - 8\s-q <br />Prooertv Owners Adiacent to Vagated Area fif Necgssarv Attach more sheets as needed.f <br />Name Lc\Le Lw 9o t+ <br />Address .3.r I l-t-v.e e 4.* ht \ .(t. D Cle- € 1..,-t L.J", <br />PhoneNumber 4Zq- 3c,l -8t'Lg <br />Name <br />Address <br />Phone Number <br />Location {Anv of the followino. please be as accurate aqpossiblgl <br />Ktffitas County Publlc Works is w'llling fo assisf with this proeess if the applicant or designated agent <br />tpgussts assisfance. <br />Leoal Descriotion: <br />(c*r ttl d.a.or!s7 EOI 'gt."l o",".J c17 t '33'l <br />OR <br />411 N. Ruby, Suite #1 <br />Ellensburg, WA 98926 <br />TEL <br />FAX <br />(509) e62-7523 <br />(509) 962-7663