HomeMy WebLinkAboutROW Permit - Hawthorne Drive Carmel-030819-8RIGHT-OF-WAY PERMIT
PERMIT NUMBER: 03021�T
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P P y 9+ � 4
creel Engineering Dept.
TODAY'S DATE: '0 $ z o/f ESTIMATED DATE OF WORK:
APPLICANT (Person doing the work) UA,(r L% i-4/so")
COMPANY:
pey- Desf« $v;Id
ADDRESS: 0(';' GR is C -V- +) .i 1 l�C ,rel '-� ioJ LZ -
PHONE: 2, -?ti it EMAIL PERMIT TO: �ycats►4y.i +tol t cawa.t c�
CUSTOMER: "�Ci0.f1 ,' ��}}
ADDRESS: S�$ /�Ac nr./1� !Jnye- il�n s- , Q t/&,33
PHONE; 317 - 3 3Z - 5/35
ADDRESS OF PROJECT: 5795
DESCRIPTION OF WORK )check all that apply)
,ROAD BORE DRIVEWAY REPLACEMENT
CONSTRUCTION ENTRANCE LANE CLOSURE
STREET CUT ROAD CLOSURE
OTHER J
DESCRIPTION:
TYPE OF SURFACE CUT (if applicable):
*NOTE: OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW) APPROVAL"
USE OF HEAVY EQUIPMENT YES NO
DRAINING ATTACHED YES NO
*NOTE- ON REVERSE SIDE OF THIS PERMIT, PROVIDE NAMES AND CONTACTS OF ALL SUB -CONTRACTORS INVOLVED
SURETY BOND. Please see Item 41 of the Right -of -Way Conditions.
BONDING COMPANY: Jr L Z- 1fr5,,fA,+C_e Carr
;BONDING NUMBER: L 07
EXPIRATION DATE: =>-O ? :
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:
(CityOfficial)
COMMENTS:
W • �. / �f/ O/Z l
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) (pate Released)
SITE PLAN
SCALE I' = 10'-0"
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