HomeMy WebLinkAbout14050081 Right-of-Way Permit i
�'0 RIGI-IT-OF-WAY P�RIIIT
� PERyIIT NO:
Note: Open cuG in p�vemenl require I3oard of Public �Vorks (BP�V) Approval
ADDRESS OF bVORIC: �' /0 �v/LQ WOGQ
DESCRIPTION OF �VORK (check all that apply): Road Bore Constnic[ion Entrance
Street Cut_ Driveway Replacement_ Lane Closurz _Road Closure_Other�q.�D-oNTOP
oF E'�'/S'fivG
USE OF HEr1VY EQUIP,�fENT (yes or no):�/�IF YES, TYPE OF HE.4VY EQUIPMENT (Bobca[ or
lar;er) TO BE USED:/ROD�`1 O,t� TOP p� C—SVST/.�j�
�
TODAY'S DATE:r/� ESTL�fATED DATE OF �'JORK: �G.f"'J f6`_ � LJ
TYPE OF StJItFACE TO BE CUT (if applicable}: /�,
APPLICANT'S NAD�I� (Person doitt�the work): ___�+��LL WoGiO /��/� Phone:
Address: Q,_n__/�p�c �/J'�U /'�{/���t /,/j
�VHO [S APPLICANT DOING �VORIi FOR: Name: 1/�V,d L TOrl3Y 1/i4Q �,/��j�
Address: ��A�L1� w�p Phone: �pL ,����
DRA4VING ATTACHED (yes or no)T�S
NOTE: ON REVGRSE SIDE OF THIS PERMIT, PROVIDE NAIviES AND CONTACTS OP ALL SUB-
CONTRACTORS TO BE INVOLVED IN ON-SITE �VORK ON THIS PROJECT.
SURETY BO\'D: Please see Item #1 oFthe Ri�ht of�Vay Conditions
BONDING COMPANY: QN ,C/LF" BONDING #
As crpplicn�it for this riglzt-of-i»ay per�nzit, l i����derstc�nd and agree ao c�ll t/�e specifications ailcf co�tdi(io�is
listed on lhe atlached sheet. '
.
/�O ��/"//�I! '� �9U//�Q/ (�PPlicant'sSgiracrr
PER�IIT GRANTED BY: �� J �j — I2 ��1�
(City Official) � (Date Issued)
RIsPAIR�\'ORI{INSPI>CTLD AND APPRO�'�D
I have inspected the repzir oi the zUove ri�ht-of-�aay and find it lo be completel_y satisfactory.
(City Inspecto�) (Date Released)