HomeMy WebLinkAboutrightof way PermitRIGHT-OF-WAY PERMIT APIDROVED
PERMIT NUMBER: 0 Z Q5"% %-/
TODAY'S DATE:
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ESTIMATED DATE OF WORK: 3 - -IT
APPLICANT (Person doing the work)
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COMPANY:
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ADDRESS:
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PHONE:
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EMAIL PERMIT TO:'W
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CUSTOMER:
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ADDRESS:
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PHONE:
PHONE:
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OF PROJECT: Aj G U S T -A L jY . C.,WW IFt Z
DESCRIPTION OF WORK (check all that appl
ROAD BORE ❑ ZZ,`I o D IVEWAY REPLACEMENT ❑
CONSTRUCTION ENTRANCE ❑ E CLOSURE ❑
STREET CUT ❑ ROAD CLOSURE ❑
OTHER ❑
DESCRIPTION: A t-cs, FAck c �
TYPE OF SURFACE CUT (if applicable):
*NOTE. OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW) APPROVAL*
USE OF HEAVY EQUIPMENT YES n NO � P�T3 CAT -
DRAWING ATTACHED YES L��Jj 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: G
BONDING NUMBER:
EXPIRATION DATE: �• `.���
As applicant for this Right -of -Way Permit, 1 understand and agree to all of the specifications and
conditions listed on the attached sheet.
(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)
ing Dept.