HomeMy WebLinkAbout14070070 Right-of-Way Permit �
RIGHT-OF-WAY PERMIT ,�i � P � � ►,/ � �
PERMTT NO: � Y
Note: Open cuts in pavement require Board of,Public Works (BPW) Approval
ADDRESS OF WORK; 11091 HINTOCKS CIRCLE N
DESCRIPTION OF WORK (check all that apply): Road Bore . Construction Entrance X
Street Cut_ Driveway Replacement_ Lane Closure_Road osure Other
USE OF HEAVY EQUIPMENT (yes or no): c/��f IF yES, TYPE OF HEAVY EQUIPMENT (Bobcat or
larger) TO BE USED: . LOADER, BA KHOE �L,;,r p �/2coi�/�
/
TODAY'S DATE: 7/OS/14. ESTIMATED DATE OF WO�: 7/16/14
TYPE OF SURFACE TO BE CUT(if applicable): /� p �v h
APPLICANT'S NAME (Person doing the work): TE�Y PooL Co. ,INC phone: 317-872-2502
Adciress: 10350 NORTH MICHIGAN ROAD CARMEL, IN 46032
WHOISIAPPLICANTDOINGWORKFOR: Name: MR• & rt�s. Bttn� waxn
Address: 11091 HINTOCKS CIRCLE CARMEL, IN 46032
Phone: 317—;07—;099
DRAWING ATTACHED (yes or no) Yes � "�
� �� �� �� � � � (� � l,7 �� � �
NOTE: ON REVERSE'SIDEOF THIS PERMIT, PROVIDE NAIvIES AND CONTACTS OF ALL SUB-
CONTRACTORS TO BE INVOLVED IN ON-SITE WORK ON THIS PROJECT.
SiJRETY BOND: Please see Item #1 of the Right of Way Conditions
BONDING COIv1PANY: MERCHANTS B���G � IN 23214
As applicant for lhis right-of-way permit, I understand and agree to all the specifications and conditions
listed on the attached sheet.
�i/',C.c-0 �/��`�7
�ppkcan�'s Stgna ure)
PERMIT GRANTED BY: o
(City 0 al) ( at ssued)
REPAIR WORK.INSPECTED AND APPROVED
I have inspected the repair of the above right-of-way and find it [o be completely sa[isfactory,
(City Inspector) (Date Relezsed)