HomeMy WebLinkAbout14070059 Right-of-Way Permit ��� APPFtOR/ E �
RIGHT-OF-WAY P�RI'IIT
P�RMIT NO: (� /,/ 7/h�'a2
Note: Open cu[s in pavement require Bo�rd of Public �Vorks (BYR') Approval
' ADDRESS OP WORK: I D,� .29 // Y.I�� �A�K
DESCR]PTION OF 1�ORK (check all that apply): Road Bore_ Construction �ntrance �
Street Cut Driveway Replacement Lane Closure Road Closure Other
USE OF HEAVY EQUIPIvIEl�'T (yes or no):� IF YES, TYPE OF HEAVY EQUIPMENT (Bobcat or
larger) TO BE USED: _� O,gGI��� �L/ //�Qy Tf� f/Gff
TODAY'S DATE: � ' 9' I'I�" ESTIMA'LED DA7'E OP WORK: St�Ly ,Z / Sr
TYP� OF SURFACE TO BL CUT (if applicaUle): /'U�
APPLICANT'S NAMG (Person doing the work): GAS6 �s/�EMODEu'�'hone: `3 � �� g�E�2'��i
Aad�ess: /C� �i Gt� G/}h Nf EL I}�,�� ✓E G�}Q M �G� /il/ 5�6 o z1 z
WAO IS APPLICANT DOING WORK FOR: I�Tame; /"/diV�ep t �ieNAFiD kv,�E�
3/�
Adclress: I d��NYDS � �� 03� Phone: r;Q�Z ,Z�
DRAWING A"fTACl-IED (yes or no)
NOTE: ON REV�RSE SIDE OF THIS PLRMIT, PROVIDE I�'AMES AND CONTACTS OPALL SUB-
CONTRACTORS TO BE I1�'VOLVED 1N ON-SITE WORK ON TH1S PROJECT.
SURE"CY BOND: Please see Item nl of the Right of Way Conditions
BONDING COMPAN�': Sf/�P/�LC�� INS. BONDING #
As ttpplicn�rt for tltis ��ight-of-tia�ay pei•mit, I understci�id ancl cr,;ree t all tbe specifica�` �nd condidions
listed o�i tl�e attached sheet.
(Ap ic�u t's gnalw�e)
PBRMIT GRANTED }3Y: C
ity Offici (Date Issued)
REPAIR ��'ORIi INSPTCT'�D AND APPROV�D
I have inspected tlie repair of the aUove ri�ht-of-�n�ay and find it to be completely satisfactory.
(City ]nspectoi•) (Date Released)