HomeMy WebLinkAbout131STR - Right-of-way Permit ApplicationRIGHT-OF-WAY PERMIT
PERMIT NUMBER: 1 9 01 0 0 2 3
TODAY'S DATE: 2-/T/ I q ESTIMATED DATE OF WORK: 2-18-)q
APPLICANT (Person doing the work)
COMPANY: ll Adele Wb0✓ Bw Id iyy
ADDRESS: 3L Ft rF rfi N!: Cg,-eI IN V603-L
PHONE: 631,(' EMAIL PERMIT TO: P¢rn;f S - 6c afti rs�J (aC,F*�
CUSTOMER: yv
ADDRESS:
PHONE:
ADDRESS OF PROJECT: I G SO tv
DESCRIPTION OF WORK (check all that apply)
ROAD BORE DRIVEWAY REPLACEMENT 0
CONSTRUCTION ENTRANCE LANE CLOSURE El
STREET CUT E] ROAD CLOSURE
OTHER 0
DESCRIPTION: Se]5 3acow
TYPE OF SURFACE CUT (if applicable): 0.1-- mix 'tat „y as
OF RVH�O-L a
*NOTE: OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW) APPROVAL*
USE OF HEAVY EQUIPMENT YES NO 's+ -'-+
"t' t
w: U .t be d.r"'
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: L.'6t-,IV M -F-+1 /04,4 LgJv.(1:y
BONDING NUMBER: 6 0 111614 7
EXPIRATION DATE: 3131 102.0
As applicant for this Right -of -Way Permit, 1 understand and agree to all of the specifications and I
�71conditions list eq thettached sheet.
4. CZ.k�
(Applicant's Signature) (Print Name)
PERMIT GRANTED BY: DATE ISSUED:
(City Official)
COMMENTS:
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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