HomeMy WebLinkAbout030719-10RIGHT-OF-WAY PERMIT
PERMITNUMBER: 03a7) a —/D
OV4 F.
TODAY'S DATE: 3 Z v(c ESTIMATED DATE OF WORK: 4F�IL /ZG, ZApriel Engi r
APPLICANT (Person doing the work)
COMPANY:
ADDRESS:
PHONE: y�/ - `? /U'�(�� EMAIL PERMIT TO: ;yE= Fl N
CUSTOMER: S F F C Uc TT
ADDRESS: 2 �i /vU�r(� �iI FOtZP �OtD
PHONE: S L T )L(
ADDRESS OF PROJECT: Zai C 1-tLFL-D t-Li40
DESCRIPTION OF WORK (check all that apply)
ROAD BORE ❑ DRIVEWAY REPLACEMENT
CONSTRUCTION ENTRANCE ❑ LANE CLOSURE
STREET CUT ❑ ROAD CLOSURE
OTHER
DESCRIPTION: 0C,&t2 JZII-HT -(f,�F `L`r
TYPE OF SURFACE CUT (if applicable): ;AjL)N �
•NOTE: OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW) APPROVAL -
USE OF HEAVY EQUIPMENT YES NO
DRAWING ATTACHED YES U 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. I
BONDING COMPANY: 1,'5T�t2iti SvTY LG�''(f�f�N`�
BONDING NUMBER: S �i
EXPIRATION DATE:
As applicant for this Right -of -Way Permit, I understand and agree to all of the specifications and
conditions listed on the attached sheet.
Annlir M'c Sienature) (Print Name)
I PERMIT GRANTED BY:
MENTS:
(City Official)
C,v,O. /j' 77Sr
DATE ISSUED:
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)