HomeMy WebLinkAboutMX-4111N_20131023_133044.pdfRIGHT-O�-WAY YERi�IIT
PEI2ti�LIT Nfl: /ca��/��-�
PERilITT ISSU�D FOR �F'ORK tiVITHTiti CITY RIGHT-OF-WAY AIYDIOR CO�iSTUCTION E1V'TRANCE OR
COVS'I`RUCTION fiRAF'FIC FRO1�S TAE RIGHT-OF-�VAY
tdt�te; Open cuts in pnvement reguire Eoard of Public �Vor(�s ($1'4V) Approval
ADDRESS OF lb'ORK: �L%r3i' �Y"t�t.a..-�e6.�.. ��y+2�
DESCRIPTIQN OF �VORK (check a(1 that appty): Road B�ce Construction.Entrance �C
Strzet Gut __ Drive�vay Repiacemeat Lane Closure Road �:losure Otber
USE OF I�AVY EQUIPISENT (y�s or no): `�� IF YES, TYPE� OF HEAVY EQUTPi�r1ENT (Bobcat or
�arger) 'I0 BE USED; ��.q� j,:��
TODAY'S DATE:
ESTI1��.�TED DAfiE OF �VORK: (� ��,���3
I'YPE OF SURFACE TO BE GUT (if applicable}:
APPI.ICAiVT'51Y��T�, (Person doing th� 4vo;k): 1��� �;,,,�(�� Phone: �(�� 2'f� ��iC�{
Address: �� t(S '�%✓d�,C, c ess 1i.��� �r-cC�c�ri,a t�� '"�a,r YCo2�t f
IVFIO IS :1PPLICA�iT I3DIivt� �VORK TOR: Name: _� ,q-4 ��s� C �a �t' `�� �
Acldress: t`-tt( �, tt(e� sr-. i�-��L �s.r =(CoC732.. Phone:
DRA�VT�fG ATTACHED (yes o: na) ��
NOTE� ON REVERSE SIDE OF THIS PTRNIIT, PROVIDE Nt1i�iES AI�tD CC}NTACTS OF ALL SUB-
C�NI'RACTORS TO BE Il�,'VOLVED IN ON-SIT� WOP�K ON THIS PRC�JECT.
SURETY BONI): Please seP Iten7 #7 of the F.ight of Way Conditions
E30\'DNG CO�IPA� v'Y: _
,�,s a�p�'icant for� tr`rzs r�ight-of-tivcry perrriif, I unclerstnnd
listed on iFae attached sheet. '
BO�rDI:iv�G #
ag�-ee to all the speciftcutit�n� crnd con�litions
�" � �
PERltIT GR�?�7TEll BY: � �'� � �
M1
(C' , Ofnc� �� (D�:te Is�u d)
RLP.1:IPt �ti'ORI{ I�SPI;CTI�D AND f11'PRO�'�,i)
I ha��e irispeeted the� re�air of the abov� right-af-wwy and find it to be completely satisfactory.
(,Cii� Irtsoec[or} (Date Relea,vd)