HomeMy WebLinkAbout19040006 ROW PermitROVED
RIGHT-OF-WAY PERMIT P
PFRAAIT NI IMRFR• /`l 717ln /a'... 7
Dept.
TODAY'S DATE: �� ��p ESTIMATED DATE OF WORK: 4
APPLICANT (Person doing the work) I
COMPANY:llnnl���,��, L C C
ADDRESS: i� 1 S q b! P.1p. 2 Ste QOCI''
PHONE: 1Jf %-�4tf_�C1� EMAIL PERMIT TO:)\ZGlrCli�
CUSTOMER:
ADDRESS:
PHONE:
ADDRESS OF PROJECT: %,?7u
DESCRIPTION OF WORK (check all that apply)
ROAD BORE
CONSTRUCTION ENTRANCE
STREET CUT
OTHER
DESCRIPTION:
(TYPE OF SURFACE CUT (if applicable):
DRIVEWAY REPLACEMENT
LANE CLOSURE
ROAD CLOSURE
*NOTE: OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW) APPROVAL *
USE OF HEAVY EQUIPMENT YES Y NO
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: Is, I-1\.� �.i �_-)\je I-C( l
BONDING NUMBER: L/, Z I Ooa 0G'�
EXPIRATION DATE:,
As applicant for this Right -of -Way Permit l understand and agree to all of the specifications and
conditions listed on the attached sheet.
(Applicant's Signature) (Print Name)
PERMIT GRANTED BY: DATE ISSUED: �Z
(City Official)
COMMENTS:
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)