HomeMy WebLinkAboutMIller JOb Right Of Way PermitRIGHT-OF-WAY PERMIT
PERMIT NUMBER: 07 % Z l mI -I
Y'S DATE: Q �J? ESTIMATED DATE OF WORK:
CANT (Person doing the work) J 2' &Ltg�� �ZQ51 0:�S
COMPANY:
DRESS:
PHONE: 317 361 -3 J/ EMAIL PERMIT TO:
CUSTOMER: Af lLG,FF
ADDRESS: ` 3 .If-tieW �7`-b �'� C �i.3 L`6Q
PHONE: 7 ! -3— G 3—% 3 3 7Z '
ADDRESS OF PROJECT: l 3 3 3 6i���
DESCRIPTION OF WORK (check all that apply)
ROAD BORE _ DRIVEWAY REPLACEMENT ❑
CONSTRUCTION ENTRANCE _ LANE CLOSURE
STREET CUT ROAD CLOSURE
OTHER
DESCRIPTION:
TYPE OF SURFACE CUT (if applicable): ti U
*NOTE: OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW) APPROVAL*
USE OF HEAVY EQUIPMENT YES NO
DRAWING ATTACHED YES I, 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. 0 Q P�
BONDING COMPANY: t)1^O
BONDING NUMBER: 6 G 0 T 73 G S
EXPIRATION DATE: �$ STD Zdc ..,
As applicant for this Right -of -Way Permit, I understand and agree to all of the specifications and
conditions listed on the attached sheet.
,,1 1jla9 i
(Applicant's Signature) (Print Name)
PERMIT GRANTED BY: r L.p , DATE ISSUED: 7
(City Official)
COMMENTS:
Lv.O• /727j%Z
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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