HomeMy WebLinkAboutRight of Way PermitRIGHT-OF-WAY PER��IT
PERMIi' NUMBER: ? C'L o,, o
TODAY'S DATE: bl 20 / I'l ESTIMATED DATE OF WORK- _ ��L251 I f
APPLICANT (Person doing the work) _Vm4
COMPANY: LCajShCkAly
ADDRESS: f`I C0q Z Z ?_1 I�V15 ,.A'
PHONE: 31 "j. "� EMAIL PERMIT TO: l�ri5l EYI�r� r5hn'er I1��re S,
MEIN:
ADDRESS:
PHONE:
0- 431-U0IL)
ADDRESS OF PROJECT: �� j'a SlV T
DESCRIPTION OF WORK (check all that apply)
ROAD BORE i DRIVEWAY REPLACEMENT
CONSTRUCTION ENTRANCE LANE CLOSURE
STREET CUT ROAD CLOSURE
OTHER
DESCRIPTION:
TYPE OF SURFACE CUT (if applicable):
"NOTE: OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW) APPROVAL*
USE OF HEAVY EQUIPMENT YES NO
DRAWING ATTACHED YES T NO 1743
*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.
BONDING COMPANY: i C)ow l C,_Q
BONDING NUMBER: p 3 j
EXPIRATION DATE: W7 I Z2140 20
As applicant for this Right -of --Way Permit, 1 understand and agree to all of the specifications and
conditions listed on the attached Wle
t.
,�
(App pcant's Si re) (Print Name)
at a M I ffe:711w11-YA
(City Official)
COMMENTS:
DATE ISSUED:
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)
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