HomeMy WebLinkAbout19060054 Right of Way PermitHV I R
RIGHT-OF-WAY PERMIT
PERMIT NUMRFR-
1-:2rmel tngineer!l?�
TODAY'S DATE: ESTIMATED DATE OF WORK:
APPLICANT (Person doing the work)
COMPANY: New
ADDRESS: F 74 OLy T I WCG{--t i s led I N 4 4
PHONE: 31l•ci'-%D �J�'�IS2 EMAIL PERMIT TO: CnGhcme, -n
CUSTOMER: TQdGI Z VoLA �
ADDRESS: 12q &3 Gr'eny, I Ie Sj .
PHONE: (r7�G1 ) ti--L�-C)32
ADDRESS OF PROJECT: 2 Q 35 Sf . r'ew c_-f ��Fe rr�c,1, N 4(GQ3 2
DESCRIPTION OF WORK (check all that apply)
ROAD BORE DRIVEWAY REPLACEMENT
CONSTRUCTION ENTRANCE LANE CLOSURE
STREET CUT ROAD CLOSURE F7
OTHER
DESCRIPTION:
(TYPE OF SURFACE CUT (if applicable):
*NOTE: OPEN CUTS /N PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW I APPROVAL*
USE OF HEAVY EQUIPMENT YES NO
DRAWING ATTACHED YES, NO h
*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: WeSt�i')� "r—tam Gc�1 ,V/
BONDING NUMBER:
EXPIRATION DATE:
.0, I
As applicant for this Right -of -Way Permit, I understand and agree to all of the specifications and
ditions listed on the attached sheet.
M i L -)eA' c ( L_ .-
(Applicant's Signature) (Print Name)
PERMIT GRANTED BY:DATE ISSUED:
(City Of icial)
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)
Dept.
gggjui S 2M4-g
A N N y-sg_ o Z A m N
m �5A Oy
mpp�zCNNp
MOAI�IT m$,�Z pD
D0pKm VZSAZN
<: N mN N;
� g
S a
�z��oi�
c;o
z�+i cyouy
0D
loco
o
m
CD O f/1
m
py6�
�
mV
7
y2ymDN
KOFAND'*
Ati�
DDA
Z=j
m"
V
0
CD (D 0
CD
n N (n 0
yv0 08
OAADmti
NW
Z.O
DZO
Im+ID
ADO
�
p
rm
5yy� j
poAZ
L�
ODMy
mom
pgR
oZ<
<
Da
o
A C
;:D
N
<o
m
1
r 1
O %
N
m I
I
/
O
%
rn
z
�
0
71
O
y,�
Gi
0
r
^
r
C
W
a
C�
8
a
Y
/ �
R
i•i
Iq=I•
M
O
m
MAW i ------
1
¢� inns
Or
C
co
% /
Z
n
% /
/
o
m o �
o a
o rn
D 0 0
> >
a
/a
N
of X
fD Cb
$
A
O
co
^' s
ww o
m A F. O
mmmFjo
e� >o
Z FFz
Z
�o'g�
m rvo
�
5
• o g �
[/++7m{{7{
loz
D