HomeMy WebLinkAbout19020080 Approved ROWRIGHT-OF-WAY PERMIT
PERMIT NUMBER: 03
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TODAY'S DATE: j—�f ESTIMATED DATE OF WORK: I`'aF` �`OI �t'glnet?
APPLICANT (Person dog the work)
COMPANY: a
ADDRESS: ' ` p Q
PHONE:!/ .l�L EM A PERMIT TO:
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CUSTOMER: it •'`–�`� r ► �/ 1 �' a ri ("ler V—
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ADDRESS:
PHONE:
ADDRESS OF PROJECT:��'��� C a+�•rri +
DESCRIPTION OF WORK (check all that �aPp Y)
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ROAD BORE DRIVEWAY REPLACEMENT
CONSTRUCTION ENTRANCE
LANE CLOSURE (– i
STREET CUT [� ROAD CLOSURE
OTHER �l
DESCRIPTION:��
TYPE OF SURFACE CUT (if applicable):
*NOTE: OPEN CUTS /N PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPWI APPROVAL*
USE OF HEAVY EQUIPMENT YES 7," NO
DRAWING ATTACHED YES 'I 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:
BONDING NUMBER:
EXPIRATION DATE:
As applicant for this Right -of -Way Permit, / understand and agree to all of the specifications and
conditions list d on the attached sheet.
licant's Signature) `
(Print Name)
PERMIT GRANTED BY:
(City Official) DATE ISSUED:
COMMENTS: /J
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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