4. INITIAL DETERMINATION REQUEST PAB-0148.PDF
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Cm MARICOPA COUNTY DEPARTMENT OF TRANSPORTATION ( Bas \ 2901 W. Durango Street e Phoenix, AZ 85009 > Phone: (602) 506-4178 oun. PATENT EASEMENT ABANDONMENT INITIAL DETERMINATION Contact Information Applicant Name: RJ Jensen Mailing Address: 10357 N. 68th Lane City: Peoria State: AZ Zip: 85345 Phone (312 )- 270 — - 9223 Email: easy.email@comcast.net Parcel Detail Assessor's Parcel Number: 210 - li - 018 1. Location of Request: (ex: 3200 W. Dove Valley Road, Phoenix) 25955 N. 15th Ave, Phoenix, AZ 85085 2. Description of Request: (ex: Abandon Easement bordering the South side of parcel 123-45-067A) APN 210-11-018 - West, East and North PAB - abandon all Patent Easements; South PAB - Abandon the north 18ft retain the south 15ft 3. Access Certification: I certify, under penalty of perjury, that no loss of currently existing legal and physical access to any property will occur if the County grants the patent easement abandonment requested in this initial determination. Signature y=— 8-21-2020 Signature of Applicant Date Maricopa County Use Only Pp M I dD PAB Number: Initial Determination Fee*: $250.00 &3 464 B46 333 oO Total Received ky ») Date: Bd IORecd By’ ig SE | * The Initial Determination fee is NOT refundable. Make checks payable to: MCDOT 2901 West Durango Street Phoenix, AZ 85009. Maricopa County Department of Transportation 2901 W. Durango Street Phoenix, AZ 85009 Permit Receipt Payer Name: Receipt #: 100362 PETER WHITE Payment Date: 8/24/2020 P.O. BOX 389030 Reference #: APN: 210-11-018 CHICAGO, Illinois 60638 Patent Easements Receipt Type: Payment Items Description Payment Type Transaction # Amount 25955 N 15TH AVE // PHX AZ // 85085 Credit Card 3787870333 $250.00 Total: $250.00 Payment Receipt Page 1 of 1 IAROPACOUNTY wxcoerconnt PE Q@vicDOT Maticopa County O nrunsrontarion Mepartivent of transportation MCDOT Permits Thank you for your payment. Please print this receipt and keep it for your records. Clerk ID : A. RAMIREZ Customer Name: PETER WHITE Reference Number : APN: 210-11-018 Product Description Payment Amount Patent Easements 1 $250.00 Payment Amount: $250.00 Receipt Number: 3787870333 Transaction Date: 08/24/2020 10:08 AM Payment Typo: [visa AccountNumber: *1154 é —— l agree to pay this obligation according to the terms outlined in my agreement with my card issuer. https://paydirect.link2gov.com/MCDOTPERMITSVT/Receipt/SuccessfulPa... 8/24/2020