HomeMy WebLinkAboutPEASLEYRIGHTOFWAYPERMITCITY OF CARMEL RIGHT -CIF -WAY PERMIT
PERMIT NUMBER: 030 S
TODAY'S DATE: O� '`�g ESTIMATED DATE OF WORK: —Z /
APPLICANT (Person doing the work)
COMPANY;
ADDRESS:
PHONE: .3 1,7- %6Z'9952-2,05
EMAIL YERMI I� f ; v 3 �O
CUSTOMER:
ADDRESS:`~ (� ► e-
,
PHONE:
ADDRESS OF PROJECT: r ()� ��,(� t ✓Pi
DESCRIPTION OF WORK (check all that apply)
ROAD BORE ❑ DRIVEWAY REPLACEMENT
CONSTRUCTION ENTRANCE LANE CLOSURE []
(STREET CUT ROAD CLOSURE ❑
OTHER
DESCRIPTION: C �'sGST�"Kc:7.�Lt E�245 �IR a.slttizS y� C'�
TYPE Of SURFACE CUT ('rf applicable): 1,)14
"NOTE OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW) APPROVAL `
tISE OF HEAVY EQI.IIPMEN7 YES NO 8
DRAWING ATTACHED YES 9� N()
_NOTEzON REVERSE SIDE OF THIS PERMIT, PROVIDE NAMES AND CONTACTS OF ALL SUB -CONTRACTORS INVOLVED
SURETY BOND. Please See iter -r nl of the night-nt-Way Cnndit,inns
BONDING COMPANY: C KS u-ra N -G -f' GCS,
BONDING NUMBER LSMIciI ao9j`
EXPIRATION DATE .dZ --
As applicunt for this Pu irt-of-bVcy Permit, f understcnd and cgree to 0 cf the• Specificcticns and
c'onditiorns listed nn ; e nttached sheet.
laPlicank s �gnatur4} (Print N)m(-)
PERMIT GRANTED BY: DATE ISSUED:
{City GffiCiof)
COM1,RNTS: F11-1
woo.
REPAIR WORK INSPECTED AND APPROVED
I leave mspacted thE, rt,p,lir of rh,p ahov- right -of -w iy a.nd find 1 to be ccnipletely satisfactcry.
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