Loading...
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)