Loading...
HomeMy WebLinkAboutrightofway 4RIGHT-OF-WAY PERMIT PERMIT NUI ISM. #Q A P P P (D � 'P: D" TODAY'S DATE: ' ' ESTIMATED DATE OF WORK. - � APPLICANT (Person doing the works r COMPANY. ,� � � = r . ADDRESS:' PHONE: j S - EMAIL PERMIT TO CUSTOMER- ADDRESS:, [ PHONE: ADDRESS Of PROJECT: L % d.,`" f 0ESCRIPT10N OF WORK jcheck a]I that apply) _ ROAD BORE DRIVEWAY REPLACEMENT CONSTRUCTION ENTRANCE LANE CLOSURE STREET CUT ROAJT CLOSURE CPTH E R _ DESCRIPTION- TYPE Or SURFACE CUT (if applicable)- *NOTE: OPEN CUTS IN PA VEMEN T REQUIRE BOA RD OF PUBLIC WORKS (DPW) APPROV Ai USE OF HEAVY EQUIPMENT ''ES }x ND _ DRAWING ATTACHED YES NO 1 `NOTE: 01Y REVERSE 51 GE OF THIS PERMIT, PROVIDE KAMES AND CONTACTS OF ALL 5UI3--CONTRACTORS INVOLVED SURELY BOND. Please see Item 41 of *he Right -Way C nditions- BONDING COMPANY: BONDING NUMBER: .� EXPIRATION DATE= f 4s ap rrt for as Right -of -1 oy Permit, f understand and agree to ate of the specr-fxacioels and conditions fisted on thea pached sheet (App11Can#'s Signa afire) (Print Name) PERMIT GRANTED BY: (City Offirial) COM M E NTS: DTE 15SUED: //l0, L --k L2,� Z-7 J 4 7 REPAIR WORK INSPECTED AND APPROVED I have inspected the repair pf the above right-of-way and find °t to be completely satisfactory. (City Inspector) {Date Reieased]