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)