HomeMy WebLinkAbout651FA - ROW PermitCITY OF CARMEL RIGHT-OF-WAY PERMIT APPROVEED
PERMIT NUMBER: O / Z3/ � Ll
Carmel Engineering Dept.
---------------------------------
TODAY'S DATE: } Z8 i ESTIMATED DAT//E OF WORK:
APPLICANT (Person doing the work)
COMPANY:
ADDRESS:
PHONE:
CUSTOMER:
ADDRESS:
(PHONE:
EMAILPERMITTO: �', Q..•Lv'JC'� w �c •c.�.�
ADDRESS OF PROJECT: 651 1 A \A5_1 nJ(
DESCRIPTION OF WORK (check all that apply)
ROAD BORE El DRIVEWAY REPLACEMENT
CONSTRUCTION ENTRANCE Q LANE CLOSURE [�
STREET CUT Q ROAD CLOSURE 71
OTHER ID
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 n
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:-''���T
BONDING NUMBER:
EXPIRATION DATE:
As applicant for this Right -of -Way Permit, I understand and agree to all of the specifications and
conditions list�vhe attached • beet.
(Applicant's Signature) (Print Name)
PERMIT GRANTED BY: DATE ISSUED:
(City Official)
COMMENTS:
W o 1337/
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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