HomeMy WebLinkAboutRight of Way Permit ApprovalCITY OF CARMEL RIGHT-OF-WAY PERMIT P �� e
PERMIT NUMBER: 03i5l ;� � .,
TODAY'S DATE: ESTIMATED DATE OF WORK:
APPLICANT (Person doing the work)
COMPANY: ,, ; �y�
ADDRESS: 0 I ct t� S� u �' C �� CA A
PHONE: ISO aA,4013s a EIVIAIL PERMIT TO:
CUSTOMER: y-w.J`�
ADDRESS: 12 �` 5I� z I �� 1 , <� ¢\ �'�-� ) I-j
PHONE: -1 �, O5S
ADDRESS OF PROJECT:
DESCRIPTION OF WORK (check all that apply)
ROAD BORE DRIVEWAY REPLACEMENT
CONSTRUCTION ENTRANCE ® LANE CLOSURE
STREET CUT ® ROAD CLOSURE
OTHER
DESCRIPTION: Cz�
TYPE OF SURFACE CUT (if applicable):
*NOTE: OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW) APPROVAL -
USE OF HEAVY EQUIPMENT YES H
NO 8
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:
BONDING NUMBER:
EXPIRATION DATE:
As applicant for this Right -of -Way Permit, I understand and agree to all of the specifications and
conditions listed on the attached sheet.
(Applicant's Signature) (Print Name)
PERMIT GRANTED BY: '�'G`"�a� DATE ISSUED: /S
(City Official)
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)