HomeMy WebLinkAbout Right-of-Way PermitOF CARMEL RIGHT-OF-WAY PERMIT APPROVED
PERMIT NUMBER: 64 (!, )
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TODAY'S DATE:
ESTIMATED DATE OF WORK: ,3 ze /J,
APPLICANT (Person doing the work)
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COMPANY:
ADDRESS:
PHONE:
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CUSTOMER:
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ADDRESS:
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PHONE:
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AADDRESS OF PROJECT:
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DESCRIPTION OF WORK (check all that apply) I
ROAD BORE ✓� DRIVEWAY REPLACEMENT
CONSTRUCTION ENTRANCE LANE CLOSURE
STREET CUT ROAD CLOSURE ❑
OTHER
DESCRIPTION:
TYPE OF SURFACE CUT (if applicable):
*NOTE: OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW) APPROVAL*
USE OF HEAVY EQUIPMENT YES NO
DRAWING ATTACHED YES 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 -of -Way Conditions.
BONDING COMPANY: AbtnL1P
BONDING NUMBER: _1C(�4(,_�(nq5 3 ��
EXPIRATION DATE:
As applicant for this Right -of -Way Permit I understand and agree to all of the specifications and
conditions listed on-tI a attac ed eet.
(AppliEanVs Signature) (Print Name)
PERMIT GRANTED BY: _� � ®� —�DATE ISSUED: / 3 l�
(City Officia )
COMMENTS: b) 0. 4:�
REPAIR WORK INSPECTED AND APPROVED
I have inspected the repair of the above right-of-way and find it to be completely satisfactory.
(City Inspector) (Date Released)
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