HomeMy WebLinkAbout14070079 Right-of-Way Permit I
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RIGHT-OF-`VAY P�RNIIT
PERNIIT NO: _ Q7/�/ y— /
PGRb]IT ISSUED FOR �VORIC �V[THIN CI7'Y RIGFIT-OF-�VAY AIYn/OR CONSTUCTf ON GNT2ANG� OR
COYSTRUCTIOY TRAFFIC FRO�I THE CLIGFiT-OF-�VAY
V`ote: Open cuts ifr pavement require Eoard of Public �Vorks (BP�V) Appro��al
ADDRESS OF �VOR.K: ,�� `�j -{-IO - �� I� � � 1—
DESCRIPTIOV 0� �VORK (cl�eck afl that app(y): Road Bore_ Constniction Entrance �
Street Cut_ Driveway Rzplacement_Lane Closure_ Road Closure Other
USE OF HEAVY EQUIPMENT,(yes or no):��� [F YGS, TYPE OF FfEAVY EQU[PMENT (Bobcat or
laroer) TO BE USED: � �(L° uL U V.� -T-p-� � �V�-� �� �j'(r'2 S
TODAY'S DATE: � - ��E - (�_BSTIMATED DATE OF �VORK: _ `� — Z � - I� �- I - I �{-
TYPE OF SURFACE TO BE CUT (iFapplic�ible):
APPLICAN'I''S NANIE (Person doin, tfie.wo:k): '�-YV� �2�QC� �a y,,�Phone: 3(T �-'y<(3.G��j �
�dd�zs5: 1 (3°�3 nJ . G�r2e�y �.� �A-�i€� .�cv-� �r � �
�VIlO IS APYLICr�NT DOING �VORIi FOR; Name: "�.��.y� �S �j��� � E ��
Address: �S v Z Z e�'1ZU L C 1 C��t?�L Phone: �/7 ` �SC> '-' I l �j2\
DFtAWNG ATTACHED (yes or no)
NOTE: ON REVERSE SIDE OF TFIIS PERNIIT, PEZQVIDE NAi�LES AND CO�"CACTS OF ALL SUB-
CO�ITRf1CTORS TO BE INVOLVED I�I 0�1-SITE WORK ON THIS PROJECT.
SUP�ETYBOND: Please see ltem�1 of th,�/R�iR�ht of�Vay Conditions �
F30NDING CONfPANY: ��j-r�� �'''�"(/�TS �'j`��Q,Q���BOND[NG�r �37
��� ---�. ��.��
;{s-npplicmzt for this right-of-ti�=al'permit, I uriders[and ct cegree t a11 t{ie speci cations and conditions
listed on the att«eDted sGreet. ,
plicanC's� iannt:a�e)
PERNIIT GP�'�ITED BY: �
, 'ity OF ic ( ate lssued)
� R�PA'IR �'✓ORK INSPECT�D 4Nll APYPOV�D
J Ita��c in'spec[ed the repair of[he a6ove riohL-oF-way and find it to be complztely satisFactorv.
(City Lispectar) (Date Released)