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CUT
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CITY OF SALEM
DEPARTMENT OF PUBLIC SERVICES
CURB CUT APPLICATION
CURB CUTS ARE TO BE APPLIED FOR AND PERFORMED ONLY BY A
LICENSED DRAINLAYER IN THE CITY OF SALEM
DATE OF REQULST: CONTRACTOR: &I'mel
PROPERTY OWNER:
LOCATION OF CURB
CUT: /tfQ O An 4w U k'6
LOOKING AT PROPERTY WHAT SIDE IS THE CUT TO BE DONE: Y/ IU
LENGTH OF CUT:- FEET L
FEE: PAYABLE TO CITY OF SALEM $50.00 lip
FOR OFFICE USE ONLY
APPROVED BY: C47,y ��/� BLDG DEPARTMENT
DATE: ;C
APPROVED BY: DEPT OF PUBLIC SERVICES
DATE:
NOT APPROVED: DEPT.
EXPLANATION: