HomeMy WebLinkAbout14050203 Right-of-Way Permit ` � �E���r �r�o: 052�1� - � p P P R 0 �I � e�
Note: Open cuts m pavement require Board of Fublic Works (BPV1�Approval
.�D.��s oF ��o�: _i 3��y c—a��- C-c-� 1�--�
DESCRIPTION OF WORK(check all that apply): Road Bore_ Construction Entrance ✓
5treet Cut_Driveway Replacemenl_Lane Closwe_Road Closure_Other_
U�E OF HEAVY EQUIPbiENT (yes or no):�TF YES,TYPE OF HEAVY EQUIPMENT (Bobcat or
lzrger) TO BE USED: ��xC� � -�L /l�'��'�
TODAY'S DATE: S I� J� ESTIMATED DATE OF WORK:
TYPE OF SURFACE TO BE CUT (if appficable):
APPLICANT'S NAME (Persan doing the work):��QGI.�(Jl� G'l,t��;�..t �'f�s�l,�Phone: . CiS� - S�`t
Address � ��c� � • I�LI,''�-�i�Q�(.y,� � �4�v✓�6�`k-� � � ��d��-
WHQ I5 APPLICANT DOING WORKI-TQR'.Name: �li/Q .�Q`�,l��-�
Address: �.3��� C��?�' �-�-"�� �t'�,Q Phone:
DRAWING ATTACAED (yes or no) 1��
NOTE: ON REVERSE SIDE OF THIS PERMIT, PROVIDE NAMES AND CONTACTS OF ALL SUB-
CONTRACTORS TO BE INVOLVED IN OI�T-SITE WORK QN THIS PR07ECT.
SURETY BOI�TD: Please see Item #1 of the Right of Way Conditions
Bo�n�G coMrn�:. l.�{.x�.�!Iv�; ,� G � Borm�TG� (�010 I U�CP I
Asapplicant for this right-of-way permit, I understand and agree to a/l the specifications and conditions
listed on the attached sheet.
�L,�",�Q�
I pplica i 's Signa[ure)
4
PERA4IT GRANTEDBY: �, � �c� -2I-
(City Official) (Date Issued)
REP.�IR WORK TNSPLCTED AND APPIiOVED
I hav8 inspected the repair of the above right-of-way and find it to be completely satisfactory.
(CiYy In_spector) (Date Released)