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: CASE NUMBER: OWNER: PHONE: MAILING ADDRESS: CITY/ ZIP AGENT AGENT CONTRACTOR PHONE: MAILING ADDRESS: STATE LICENSE NO. CITY/ ZIP: EXP. DATE: BOND NO. INSURANCE EXP. DATE: ZONE ATLAS PAGE: SITE INFORMATION SITE ADDRESS: DIRECTIONS: LEGAL DESCRIPTION: UPC NO: - - - - - - LOT SIZE: Excavation Information Traffic Control Plan must be approved 72 hrs. prior to any work in the County Right-ofWay IMPORTANT: The road is: Paved Unpaved The issuance of an ex.

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