HomeMy WebLinkAbout19060182 Right of WayAPPROVED
RIGHT-OF-WAY PERMIT
PERMIT NUMBER: if 7JB )Q — �:r`3rlT1P� Fnninegrin
,�„.g Dept.
TODAY'S DATE: 77:17—i`% ESTIMATED D/%ATE OF WORK:
APPLICANT (Person doing the work) �� ��t 0 C (�
COMPANY:
ADDRESS:
PHONE:
CUSTOMER:
ADDRESS:
PHONE:
t e- �e-
317 _
ADDRESS OF PROJECT: 0w�'
DESCRIPTION OF WORK (check all that apply)
ROAD BORE
CONSTRUCTION ENTRANCE
STREET CUT
OTHER
DESCRIPTION:
DRIVEWAY REPLACEMENT
LANE CLOSURE
ROAD CLOSURE
T1
TYPE OF SURFACE CUT (if applicable):
*NOTE: OPEN CUTS IN PAVEMENT REQUIRE BOARD OFPUBLICWORKS,(/BPW) APPR�VAL*
USE OF HEAVY EQUIPMENT YES NO t� n�P�
DRAWING ATTACHED YES NO
*NOTE: ON REVERSE SIDE OF THIS PERMIT, PROVIDE NAMES AND CONTACTS OF ALL SUB -CONTRACTORS INVOLVED
As plican this Right -of -Way Permit, 1 understand and agree to an of the spenlicuuuns unu
conditions listed on the hed/_re�t/
(ADD ft's Signature) (Print Name)
IT GRANTED BY:
(City—Official)
DATE ISSUED: 7/1
COMMENTS:
o ZZ/V02?-5-
REPAIR
7/183SREPAIR 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)