HomeMy WebLinkAboutROW PermitAPPROF_sr
RIGHT-OF-WAY PERMIT
PERMIT NUMBER: 6 b .3
Carmel Engineering Dept.
TODAY'S DATE: �'zol� ESTIMATED DATE OF WORK: 2 I - C( t
APPLICANT (Person doing the work) l V-e �� SSW k
COMPANY: CNSC 0' -SIGN I ilErtaD(LlrJbr
ADDRESS: (,AA/A 6 L <uJlrz ) oo Ck-911r 1-ZIA 9�032-
PHONE; �j,R'(�- �{00 - �(o� °� EMAIL PPEERMIT TO:
CUSTOMER:
ADDRESS:
PHONE: 24e2— Sb) - 5$))
ADDRESS OF PROJECT: �-,24� DL* VE,
DESCRIPTION OF WORK (check all that apply)
ROAD BORE DRIVEWAY REPLACEMENT ❑
CONSTRUCTION ENTRANCE ❑ LANE CLOSURE
STREET CUT C ROAD CLOSURE
OTHER V/ _
DESCRIPTION:
E OF SURFACE CU
*NOTE: OPEN C!
USE OF HEAVY EQUIF
DRAWING ATTACHES
r-j
I *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: � DVh. CAS,/kLt!t
BONDING NUMBER: e4 2- S `)2-
EXPIRATION DATE: 'Z (at 2oso
As pplicant for this Right -of -Way Permit, ! understand and agree to all of the specifications and
conditions listed on the attached sheet.
�&((k T:>
(Applicanos ig afiure) (Print Name)
PERMIT GRANTED BY:
(City
COMMENTS:
l3�zl�o3
DATE ISSUED: Z
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)
C.,c
s
g�
C., j
R
BQ
!.Ohl
IN
ZE094VNVIONI _13WiIVO
BANG Nnd Boa SE6
AgISVgd H139 T NHor
ONIAI
uooaino'R N01110(lv HOUOd
30N30IS3U A31SV3d
I
zl.
ci
M
LU
0
rl
ri
E
z
0