HomeMy WebLinkAbout17030177 Right-of-way PermitAPPROVED
CITY OF CARMEL RIGHT-OF-WAY PERMIT
PERMIT NJM3ER/9V^yj//7-/
Carmel Engineering Dept.
TODAY'S DATE:
\3^0 (rxA U^^k
APPLICANT (Person doing theiv/ork)
COMPANY: VdlWAfg C ^S'
A0DRE5S:
PHONE:
CUSTOMER:
ADDRESS:
PHONE:
*/ r 1 ESTIMATED DATE OF WORK: L;'^nn^ck^^ / if-»I '^/^ H
10 M 0 ^ ^'^^ EMAIL P ERM IT TO: fi\(\^t\^' 1 g U^.U^.^/^^
ADDRESS Or PROJECT:
DESCRIPTION OF V/ORK (check all that apply)
ROAD BORE •
CONSTRUCTION ENTRANCE •
STREET CUT •
OTHER
DESCRIPTION:
1> (k^^\j-i^^A"3E
DRIVEWAY REPLACEMENT
LANE CLOSURE
ROAD CLOSURE
rt'PE OF SURFACE CUT (if applicable):
'NOTE: OPEN CUTS IN PAVEMENT REQUIRE BOARD Or PUBLIC WORKS (BPWj APPROVAL'
USE OF HEAVY EQUIPMENT YE5 NO
DRAWING ATTACHED Y£5 NO _
'NOTE: ON REVERSE SIDE OF THIS PERMIT, PROVIDE NAMES AND CONTACTS OF ALL SUB-CONTRACTORS INVOLVED
SURETY BOND. Please see Item #1 of the Right-cf-VVay Conditions.
BONDING COMPANY: Sty-e-<^'H >K Vy
BONDING NUMBER: \1 f;)^ S ^ \
EXPIRATION DATE: \) j H \
Right-of-Way Permit, I understand and agras to cli ofths spacifications and
conditions listed on the cttachad sheet. listed on the cttochad sneet.
(Prir.t Name)
PERMIT GRANTED BY:
COMMENTS:
/? ^ • '
(Cicy Official)
D.ATE ISSUED: // // /
REPAIR WORK INSPECTED AND APPROVED
have inspected the repair of the above right-of-way and find It to be completely satisfsctory.
(City inspector) (Date Released)