HomeMy WebLinkAboutSCHULER APPROVED RIGHT OF WAYCITY OF CARMEL RIGHT-OF-WAY PERMIT
PERMIT NUMBER: -
..&PRROVED
TODAY'S DATE: e a ESTIMATED DATE OF WORK:
APPLICANT (Person doing the work)
0w
COsVIPANY:
67 510
ADDRESS: r�t7G5, cvr
PHONE: 517- 7-9 - EPDXLPERMIT TO:
CUSTOMER:
} p rrcc �-y5 !� �• �c .���v �;oma .�.i 3S�s-miffs
i 1ADDRESS: ✓� i _ ��'i�• r _ r j
, IPH,0NE:
r X1-7
ADDRESS OP PROJECT'�'��•
DESCRIPTION OF WORK (check all that apply
ROAD BORE
CONSTRUCTION ENTRANCE
STREET CUT :K—
STREET
�+ DE5CRIPTION4e5S
DRIVEWAY REPLACEMENT ❑
LANE CLOSLFE ❑
ROAD CLOSURE ❑
TYPE OF SURFACE CUT (i: applicable):
*NOTE: OPEPI CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (SPW) APPROVAL"
USE OF HEAVY EQUIPMENT YES NO
DRAWING ATTACHED YES �VlNO
*NOTE_ ON REVERSE SIDE OF THIS PERMIT, PROVIDE NAVIES AND CONTACTS OF ALL SUB -CONTRACTORS INVOLVSD
SURETY BOND. Please See Iter-, rt1 of the Right-of--�-ra�y Contiiiior+s.
BONDING COMPANY:
BONDING NuM8ER: L5. OCA
EXPiRAT!ON OATS:
,s a;p�iCant jar this Ri;ht-cf-.4'oy P�rmi I undersrand end agree to cfi of the speci;ictttions tend
conditions listed on the artachedsnLlet_
(Print Name)
licant's Signature)
3ERMIT GRANTED BY:
--OMIV,ENNTS:
(CitY-0 f icial)
DATE ISSUED:
REPAIR WORK INSPFC-TED AND APPROVED
I have inspected the repair of the above and fl r'6 Si Lo be COrnpletQh; S3ti5r2CtOry.
(City Inspector) (Date Released)
Dept.