HomeMy WebLinkAbout19030089 Right Of Way Permit3
CITY OF CARMEL RIGHT-OF-WAY PERMIT
PERMIT NUMBER: 031 mil$_ I
In.eering DO; i,
TODAY'S DATE: 3 _ ESTIMATED DATE OF WORK:
APPLICANT (Person doing the work) /
COMPANY:�yu
ADDRESS: //��✓t Z }Q
PHONE: 6 EMAIL PERMITTC.- 19�U,94tawk u �Qig E-6L411
�Joo�S.
I CUSTOMER.,
s )ADDRESS:
IPHOEIE:
ADDRESS OF PROJECT: t
10 ; (c•
DESCRIPTION OF WORK {check all
that apply)
ROAD SORE
❑
DRIVEWAY REPLACEMENT
CONSTRUCTION E^1TP,ANCE
LANE CLOSURE
❑
STREET CUT
ROAD CLOSURE
❑
.OTHER
(DESCRIPTION: /tCGG�S�
I
T� G_�r�yka
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TYPE OF SUR=ACE CUT (if applicable):
"NOTE: OPEN C{IT5 IN PAVEMENT 9EQUIRE BOARD OF PUBLIC WORKS (BPW) APPROVAL*
USE OF HEAVY EQUIPMENT YES N0 B DRAWING ATTACHED YES NO
"NOTE: ON REVERSE SIDE OF Tl;15 PERMIT, PROVIDE NAtNIES AND CONTACTS OF ALL SUS -CONTRACTORS INVOLVED
SURETY BOND. Please see Item #1 of the RIight-of-Way Conditions.
BONDING COi,:1PANY: L .- c �/� S;u cac'c e
BONDING N7UMRER: L5M f 0 (009
EXPIRATION DATE; �l,Cct �Olot,K,
As applicant far this Right -of -Way Permit, 1 understand ❑rnd agree to a!! of the �Cecificotions and
condition; listzd on the atercned sheet.
h,
licar.t's Signature} (Print Name)
P£RMITGRA.NTED BY:
(city Official)
COMMENTS:
S—Lf
DATE !SSUED: �1� /
REPAIR WORK INSPECTED AND APPROVED
1 hav2 inspec,ed the repair of the above right-of-way and find it to be completely satis=actory.
(City Inspector) (Date Released)