HomeMy WebLinkAbout14060194 Right-of-Way Permit !� �' �' �i0 °�1 � � I
RIGHT-OF.-WAY PERMIT
_ _ _
PERMITNO:' �i�"c 7�3 -V
Note:Open cuts impavement require Board of Pu61ic Works(BPW)Approval
ADDRESS OF WORK: I.�.$T5 �I�eCIL Sff�f,CarMel, 91p0,� —�Q3(-��}
DESCRIPTION OF WORK(check all that apply):Road Bore_Conshvction Entrance X '
Slleet Cut_Driveway Replacemeot_Lane Closwe_Road Closure_Other_
USE OF HEAVY 6QUIPMENT(yes or no): t5 1F YES,TYPE OF HBAVY EQUIPME�T(Bobcat or
larger)TO BE USED: RQbCGC-f� ,h eKCQVGI'�'�tr
TODAY'S DATE: "I 13 ESTIMATED DATE OF WORK: $I a I I 13
TYPE OF SIJRFACE TO BE CUT(if applicable): DI f i"
APPLICANT'S NAML(Person doingthe work):A$KIAI N CONSI YUC+ION'hone,(�-r)N4�-qq9�,
naa�ess:al59 ��e{�5�. Ste. a.�, C�rMel, � 4�o3a
�VHO IS APPLICA�T DOING WORK FOR:Name: SL1fvI('i
Address. Phone:
DRAWING AT"CACHED(yes or.no) e5
NO'fE:ON REVLRSE SIDE OF THIS PERMIT,EROVIDE NAMES AND CONTACTS OF ALL SUB-
CONTRACTORS TO BE INVOLVED IN ON-SITE WORK ON THIS PROJECT.
SURETY BOND: Please see Item�Il of fhe Right of Way Conditions
BONDINGCOMPANY: �ILt"NON C�CNef"O�I BONDING# ON'F��G
As applieant for this right-of-tvay perniit,/understand and agree to a/I[he specifications nnd coridilions
listed on die attached sheet.
�
(APpkcanr.s Signa e�
/ .
PEEt�IIT GRANTED BY: C� � c�7 3
ity�ai (Date Issued) ��
REPAIR WORK INSPECT�D AND APPROYEA
i have inspected the repair of the above right-of-way and find if to be complelely sztisfacrory. I
(Citydnspector) (Date Reteased)