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CITY OF CARMEL RIGHT-OF-WAY PERMIT
PERMIT NUMBER:
Carmel Engineering Dept.
TODAY'S DATE: J'( Zj 23 ESTIMATED DATE OF WORK: Se47 �
APPLICANT (Person doing the work)
COMPANY: ��l�ruf� P�Qt✓S CDiL
ADDRESS: SZS �LI'�iGydd V Tn��y !(Z -3p
PHONE: 3�7-78 Z– j' �(O EMAIL PERMIT TO:�0 l5
CUSTOMER: Scan f �CG� �. 6 1zz
�-S G,.�t Uri ! G25� � ra c C ,G`.�•� y/y
ADDRESS OF PROJECT:
DESCRIPTION OF WORK (check all that apply)
ROAD BORE ❑ DRIVEWAY REPLACEMENT ❑
CONSTRUCTION ENTRANCE ' LANE CLOSURE ❑
(STREET CUT E ROAD CLOSURE ❑
(DESCRIPTION: -e S$ �7px6iK 4
TYPE OF SURFACE CUT (if applicable):
"NOTE. OPEN CUTS IN PAVEMENT REQUIRE BOARD Of PUBLIC WORK5 (BPW) APPROVAL k
USE OF HEAVY EQUIPMENT YES fd 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
CondltiOnS-
•G- � � (_V
BONDING COMPANY: k•; c c,•c2
BONDING NUMBER:LS Q DC7 --7
EXPIRATION DATE: r —f,, – o
As applicant for this Right-of-Woy Permit, I understand and agree to all of the specifications and
conditions listed on the attached sheet.
(Applicant's Signature) (Print Narne)
PERMIT GRANTED BY:
(City Official)
DATE ISSUED:
COMMENTS:
75-796
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)
TCD
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