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HomeMy WebLinkAbout14070051 Right-of-Way Permit .APPROVE � RIGHT-OF-WAY PERMIT PERMIT NO: O.Z27/4 -9 1Vote: Open cuts i pavement require Board of Pubiic Works (BPW.) Approval ADDKESS OF WORK: IS� ���°n� ��L DESCRIPTION OF WORK(che k all that apply): Road Bore_Construction Entrance �! Sfreet Cut_Driveway Replac ment_Lane Closure_Road Ctosure_Other USE OF HEAVY EQUIPMENT yes or no): �IF YES,TYPE OF HEAVY EQUIPMENT (Bobcat or larger) TO BE USED: 3ob- ^�.+ni.P "(-R-�� �S CoJC�ff`T� T2u TODAY'S DATE: � / ESTIMATED DATE OF WORK: S��'7��Y TYPE OP SlTILFACE TO BE C (if applicable): N��' APPLiC�NT'S NAME (Person daing the work): �VK1CC oo� �e Phone: g �� �3Dg Address: So70� �{ �` s'�' S/�•a�AN'd�O� f �/`� 6��8 �VHCI I5 APPLICANT DOIN WORK FOR: Name: C�'` � ��3�N S Address: / v �CC� oN �'/' .4L Phone: 37� � �0a DRA\'✓1NG ATTACHED (yes o no) �� NdTE: ON REVERSE SIDE OR THIS PERMIT,PROVIDE NAMES AND CONTACTS OF ALL SUB- CONTRACTORS TO BE INVO VED IN ON-SITE WORK ON THIS PROJECT. SUR�:Y BOND: Please see Ite� #1 of the Right of Way Conditions BONUi\G COMPANY: � � � BONDING# Q �3 7P� Q��S� A�aprlicnnt jor thls ri.ght-o H�ay permit, 1 zu�de�s[aircl nnct agree to ull d�e specificc�tions m��!conditiorts li.rted rnr the a[lached sheet. 9/ C(/ ��� pplicant's Signature) PER1�iIT GRANTED BY: / Gj'Z`'� (City Officiaf) (Date Issued) REPAI WORK INSPECTED AND APPROVED I have inspected the repair of the above right-of-way and find it to be completely satisfactory. , (City Inspe tor) (Date Released)