HomeMy WebLinkAbout14040233 Right-of-Way Permit 1 �`'� qJ 'y�
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R�I_GHT-OR-�VAY P��RI�IIT
PERM[TNO: �(ov,;2i�•�
PERi�IIT ISSUGD FOR �VORK'WITFII�I CITY R[GHT,OF-�VAY AND/OR COYSTUCTiON CriTR4NCE OR
COiYSTKUCT[ON'['Rr\FFIC FROb�( TFIE�R(GHT-OF-tVAY
1`ote; Open cuts in pavement require Board of Public �Vorl:s (BPW) Approval
ADDF�ESS OF WORK: �Z���, �VC�SL �,�-rvre,L D211/E�
DESCRIPTION 0(' WORK(check all tfiat apply�): Road Bore Constniction Entrance ��
Street Cut_ Drive�vay Replacement Lane Closure ii F'.oad Closure O[her ✓
USE OF HEAV Y EQUIP�IGN1'(�or no): IF YES, TYPE OF HE:�VY EQU[P�fENT (Bobcat or
laroer)"CO BE USED: �jb �p��� '- ��c-lC.�
TODAY'S D.4TG: a S (�A-���-/ GSTIMATED DATE OF �VORK: _ � �C ;)�yN� � 4
'fYPE OF SURFACE TO BE CUT (if applicable):
AYPLICAti'f'S NAitiIE (Person doin, the work): To��n a��[ /�/��' ��s�, Phoae: 3 / 7- �{L3-/OZd
Address: S']al i�no�resS �� Z�l���wv�q%uUS i ti/ �/(,,.2y/
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1VI10 IS APPLICr�NT DOING �VORI� FOI2: 1Vame: ��j r/�o,�/ ���//
Address: �0� �r��/k'1 i� 54�are 1��,� �Ati ,�y .L�/(�hone: Z l`r �7 y 9�I�
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DRf1WNG ATTACHED (yas or o) %
NOTE: ON REVERSE SIDE OF TI-L[S I'ERi�II"C, PROVIDE NA�fES AND CONTACTS OF ALL SUI3-
CONTRACTORS TO F3E INVOLVED I�I ON-SITG �VORK ON THIS PROJEC'C.
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SURETY E30ND: Please see Item��1 oF ehe Ri�ht of�Vay Gonditions
BONDNG COMPANY:�� ��°I�t v��°sr<� BON�DIVG n C, �
As npplican(for this right-oJ-���cry perrnit, 1 unclerstarid ru7 �rore !o l ' e pecifieations cuzd cor�ditior7s
lis[ed onYhe attachecf sheet. ��L��'/�
(.�ipplicant's Signnt��r�e)
PER\�IIT URANTEU BY: @
City OEficial (Da[e Issued)
�RGP�1R lti'ORI�liYSl'GCTGll .�ND APY120VliD
1 hare inspected the repair of the above ri�ht-of=�vay and tmd it to be comole��ely satisfaetory.
� (Gih� Ins�ector) (Date Released)