HomeMy WebLinkAbout5961 Heaton Pass 1CITY OF CARMEL RIGHT-OF-WAY PERMIT
PERMIT NUMBER:
TODAY'S DATE: ,�j ��] �1 ESTIMATED DATE OF WORK:
APPLICANT (Person doing the work)��COMPANY-
ADDRESS:
PHONE: 12_-_17 r V - 3 yG ; EMAIL PERMITTO:
CUSTOMER:
PHONE:
ADDRESS OF PROJECT:
DESCRIPTION OF WORK (check all that apply)
ROAD BORE ® DRIVEWAY REPLACEMENT
CONSTRUCTION ENTRANCE LANE CLOSURE [�
STREET CUT ROAD CLOSURE []
OTHER
DESCRIPTION:r7 ' �� K, a
r
'TYPE OF SURFACE CUT (if applicable):
*NOTE: OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (SPIN) APPROVAL*
USE of HEAVY EQUIPMENT YES HNO
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 Conditions. i
BONDING COMPANY:
BONDING NUMBER:
EXPIRATION DATE:
As applicant for this Right -of Way Permit, i understand and agree to all of the specifkations and
%) _ A] ill , n , conditions listed on the atracpgd sheet
S' -'4P -'V fV f6A-e
`PERMIT GRANTED BY: ( DATE ISSUED:
Gly official)
REPAIR WORK INSPECTED AND APPROVED
1 have inspected the repair of the above right -of way and find it to be completely satisFactory.
(City Inspector) (Date Released)