HomeMy WebLinkAbout14050140 Right-of-Way Permit � ----
- RIGHT-OF-WAT' PERMIT A p P f� O �1 E p `
PERIVIIT NO: 052//� - 2
Note: Open cuts in pavement require Board of Public Works (BPN� Approval
ADDRESS OF WORK: �' (J� drj �,r oa �c cr t e u� � �A>� �OU
DESCRIPTION OF WORK (check all that apply): Road Bore Construction Entrance ,/
Street Cut Driveway Replacement_Lane Closure Road Closure_ Other
USE OF HEAVY EQUIPMENT (yes or no): IF YES, TYPE OF HEAVY EQiJIPMENT (Bobcat or
larger) TO BE USED:
' TODAY'S DATE: 'al1 !"�"` l`� ESTIMATED DATE OF WORK: �d r/�l �J`�
TYPE OF SURFACE TO BE CUT (if applicable):
APPLICANT'S NAME (Person doing the work): �/o�/ ��o� Phone: 3 (7 �.3� 3��F
Address: 3 7�'i L �/.sr��r Cr� %Z� ��.w /o/
WHO IS APPLICANT DOING WORK FOR: Name: �G� Cv..y
Address: l0�So� ��, �/c,,e,., '�c_ �'/Ira..�� i ti Phone: 3/7 SZ�'i !SS�`7
DRAWING ATTACHED (yes or no) _�
NOTE: ON REVERSE SIDE OF THIS PERMIT,PROVIDE NAMES AND CONTACTS OF ALL SUB-
CONTRACTORS TO BE INVOLVED IN ON-SITE WORK ON THISPROJECT.
SLJRETY BOND: Please see Item #1 of the Right of Way Conditions
BONDING COMPANY: BONDING#
As applicant for this right-of-way permit, I understand and agree to all the specifications and conditions
listed on the attached sheet.
� � (Applicant's Signature)
PERMIT GRANTED BY: //�i''��("GJ i�y,D S' Z I - �4-
(City Official) �- (Date Issued)
REPAIR WORK INSPECTED AND APPRO�'ED
I have inspected the repaii of the above nght-of-way and find it to be completely satisfactory.
(City Inspector) (Date Released)
� De_sc�iption:
� nbered 16 in Millbrcyok, :an Addition :fo the County of Hamiltan, os. per plat
recorded os Instrument No. 9362095, Recorded in Plat Cabinet No. 1 , Siide
the Office of the J�ecorder of Hamilton County, Indiana.
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