HomeMy WebLinkAboutApproved Right of Way PermitRIGHT-OF-WAY PERMIT
PERMIT NUMBER: 111,q -lo
APPROVED
Carmel Engineering Dept.
TODAY'S DATE: = f'�1 %! �❑ ESTIMATED DATE OF WORK:
APPLICANT (Person doing the work)
COMPANY: i�ri I /
ADDRESS:
PHONE:
STOMER:
ADDRESS:
PHONE:
317 �y�> `�SJ,s� EMAILPERMITIL-15A oe
TO: /jk'/l,Jflf�L�f'�tr'>yf�/�c L°vt`i
ADDRESS OF PROJECT: %3Z %5 ❑ �U/j'l�'%I / %'�{ ' r ► ^ i
DESCRIPTION OF WORK (check all that apply)
ROAD BORE ❑ DRIVEWAY REPLACEMENT ❑
CONSTRUCTION ENTRANCE ❑ LANE CLOSURE
STREET CUT ❑
❑ ROAD CLOSURE El
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
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:> 5 lJt / j�
BONDING NUMBER: S uy L -` Tr
EXPIRATION DATE:
As applicant or th' Right -of -Way Permit, l understand and agree to all of the specifications and
conditions listed on the attached sheet.
Y
(Applicant's signature) --- UA? 141l) 5'
(Print Name)
PERMIT GRANTED BY:
COMMENTS:
G✓. O
DATE ISSUED:
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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