HomeMy WebLinkAbout19050152 ROWRIGHT-OF-WAY PERMIT APPRO
PERMIT NUMBER: OC, j ? / ( —L�
TODAY'S DATE: ,arl�l
ESTIMATED DATE OF WORK: el E jgi ering Cepi
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APPLICANT (Person doing the work)
COMPANY: Al --
ADDRESS: 9Co 1. 9G" S4, /cx-,
PHONE: D,7 -3y7- -?jQ0 EMAIL PERMIT TO: Sdatl�5 dre�,S�ortel.eow
CUSTOMER: ,
ADDRESS: 90o G 9G *� S-� /Ov c�cy6 4o�J �/� r112 fro
PHONE: 3Y?-?3cc)
ADDRESS OF PROJECT: C13b /�G�CtN "Di. 2,co4
DESCRIPTION OF WORK (check all that apply)
ROAD BORE _l DRIVEWAY REPLACEMENT ❑
CONSTRUCTION ENTRANCE LANE CLOSURE
STREET CUT ROAD CLOSURE
OTHER
DESCRIPTION: Ntw �7D.NG Go,vb-�icrcb✓
!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: L
BONDING NUMBER: Q
EXPIRATION DATE:
As applicant for this Right -of -Way Permit, l understand and agree to ali of the specifications and
conditions listed on the attached sheet.
(Applicant's Signature) (Print Name)
PERMIT GRANTED BY:
(City Official)
DATE ISSUED: �o� /
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)