HomeMy WebLinkAboutshugars ROWDAY'S DATE:
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APPLICANT (Person doing the work)
COMPANY:
ADDRESS:
PHONE:
RIGHT-OF-WAYYPERMIT
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PERMIT NUMBER: oaL_LL -
ESTIMATED DATE OF WORK;
EMAIL PERMIT TO:
CUSTOMER:
ADDRESS:
PHONE: _
)DRESS OF PROJECT: <1.2-y
ESCRIPTION OF WORK (check all that apply)
DAD BORE
ONSTRUCTION ENTRANCE
1-REET CUT
THER
DRIVEWAY REPLACEMENT
LANE CLOSURE
ROAD CLOSURE
,ESCRIPTION:
YPE OF SURFACE CUT (if applicable):
*NOTE: OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW) APPROVAL*
1SE OF HEAVY EQUIPMENT YES 3�' NO
DRAWING ATTACHED YES NO
r•inTc. nu orvrQcc Unc nr T14K vFRMIT_ PROVIDE NAPA,",.- pCONTACTS OF ALL. SUB -CONTRACTORS INVOLVED
SURETY BOND. Please see Item #1 of the Right -of Way''
BONDING COMPANY:
BONDING NUMBER:
EXPIRATION DATE:
As applicant for this Right -of -Way Permit, 1 understand and agree to all of the specifications and
conditions li on ttt street.
(Applicant's 5ignature) (Print Name)
PERMIT GRANTED BY: DATE ISSUED: � z !zz 17
(Ctfy Oh ial)
COMMENTS:
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)