HomeMy WebLinkAboutRAW Permit and Drawing KellerCITY OF CARMEL RIGHT-OF-WAY PERMIT
PERMIT NUMBER: O -8 !� —1
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Carmel B ry Dept.
TODAY'S DATE: (,t / 2-00 ESTIMATED DATE OF WORK: �(f 6� 7 2_0
APPLICANT (Person doing the work) r0^1 Cz. s
COMPANY: ;?eY'q u * pyo6_5 CD,L P
ADDRESS:
PHONE: /17 7g2-92 ,�_6 E/MAIL PERMIT TO: iS2
CUSTOMER:
ADDRESS:
PHONE: 3(7- 7,JZ— 1 `JS
ADDRESS OF PROJECT: !(J 6 4m/Oz .1 V `j
DESCRIPTION OF WORK (check all that apply)
ROAD BORE ❑ DRIVEWAY REPLACEMENT
CONSTRUCTION ENTRANCE LANE CLOSURE ❑
STREET CUT ❑ ROAD CLOSURE ❑
OTHER
DESCRIPTION: A-&e5s `-z, VA -d
TYPE OF SURFACE CUT (if applicable):
*NOTE. OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW) APPROVAL `
USE OF HEAVY EQUIPMENT YES NO 8
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 nl of the Right -of -'Way Conditions. /
BONDING COMPANY: T cJ_ i/Lsu-C4("C
BONDING NUMBER: LS d 00
EXPIRATION DATE: �tc� N 7CJJl7
As applicant for this Right -of -Way Permit, 1 understand and agree to all of the specifications and
conditions listed on the attached sheet.
(Applicant's Signature) (Print Name)
PERMIT GRANTED BY: Ad -A-00— DATE ISSUED: 9
(City Official)
COMMENTS:
1,A20• /8/,S/S—
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)
75-1
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