HomeMy WebLinkAbout14070062 Right-of-Way Permit JUN-19-���14 05:54R FP.OM:hIRRGE MIKELS 7-8236757 T0:5712439 P. 1
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Note: Opes cata im pmvemmt reqmh�e Bosrd ot Peti13t oiks(SP'W)App►roval
- ADDRESS OF WORK �/- . O r
• DpSQtIP1'fON OF WORK(cha]c atf tlnt nPP1Y):Road Bae __, 'oa Bahaoee.✓
Sh�e�GUt -=Driveway RcQlacaaeat —L�m Ctoaue=Road =Otha ----
i7SE OF HEAVY EQUIPMEM'(yesaree):c�y IF YES,TYPS OF VY BQ(JIPMSNf(Bobcet o=
Iarger)TO BE USED: �
TODAY'S DATB: 6- I G-1 y L�S1`Ru9ATBU DATE OF WORK: '
, TYPB OF SURFAGB'PO-BB CITf(ifapplieable): —
� e+iYPUC�►Hf1''sNAMB(Pasondoiogthewo�): -F' Phono:,,�l'i-�l'��3�F�'iS
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�VHO IS APPLICAN'1'DOINC WORK FOR N�a r +
p� r j 4bd3 Phone: ���- v�o sstiy�
DRAWIIdC3 ATfACHED(yea ors��
NOTE:ON REVBRSB SIDE OF THIS.PE[tM1T.PROVIDE NAMHS CONTACTS OF ALL SLtS-
CONTRACI'ORS TO BE 1NVOLV�IN ON�TTS WORK ON�HIS OJSCI:
SURETY BOTID: Plesme see Item#1 of the Right of Way Condidoas
sormnaG c�nrrY: F� sormn�rc r�/J�� 95��'
d►aPPUrqnt f'as tht+rtgt►:-ol-wayPermir.r�otdasstmrd o,rd agne to t d,s spe+c3Jicauvns cnd co,ulwa»a
lisred on the auachsd sheec
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PERMif GRANI�D BY: - //
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I have u�tho tspaa of tho abovo right�f-way and fmd it to bo lotalyeatisf�torY• ,
(CitY'l�bOr) (Dato eleasod) . .