HomeMy WebLinkAbout19070143 ROWG
RIGHT.OF-WAY PERMIT
PERMIT NUMBER: tr7lZ n -7 ol !q Dept
ToDAYsDATE: 7'lC -t7 n
ESTIMATED DATE OF WORK: l+u.c. - I
APPUCAITT{Persondoingthework} f/ e n,.- € l,tr;,,r* 1.o., ., & r., c/f)1o.n-
COMPANY; fr<-mr c- 4 I taut t' ., u nc/-(ti.? t 4-c ,*r*
ADDRESS:tC,o/* rt-.{6. K, fz_s F- froqcqa.,L Zrt-V(trz-
PH0NE: 76J Zt{ o3*"t EMAILpERMtrro: 'fi<mrq- -et-ca.*\ca€s;.r/c.i
cusroMER: rtLf
ADDRESS: -f 7 7 I .{-q.f 1,r4", ?/;r*C ,r-rr.u(
Ft-totrtE:ZC". S Tr.t tt ? ll
ADDRESS OF pROJECT: ., j 7 .i ar. / .r11r,4 :i,1,- I i* {'2:-.rt_+{
DESCRIPTION Or WORK {check,
ROAD BORE DRIVTWAY REPLACEMENT :-
CONSTRUCT1ON ENTRANCE LANE CLOSURE
OTHER
DESCRIPTION lic j. /?tc I
TYPE OF S{JRFACE C{JT (if applicable): uo,t<-
*NOTE: OPEN CUTS lN ?AVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW) APPRAVAL*
USE OF HEAVY EQUIPMENT YES i- NO
DRAWING ATTACHED YES .T NC
+NOTE: OI{ REVERSE S|DE OF THIS PERMIT, PROVIDE l.lAMES AND CONTACTS OF ALL SUB-COHTRACTORS INVOLVED
SURETY BOND. Please see ltem #1 of the Right-of-Way Conditions.
BONDING COMPANY:
BONDING NUMBER:
EXPIRATION DATE:
As opplicont for this Right-af-Way Permit,, I understand and cgree to oll of the speciiicotions end
conditions listed on the ottoched sheet.
{ ,', / {V lncL -
PERMIT GRANTED BY: DATE ISSUED 7/ T
REPAIR WORI( INSPECTED AND AFPROVED
I have inspected the repair of the above right-of-way and find it to be completely satisfactory.
APPROVE
08/07/19
David Rutti