HomeMy WebLinkAbout19090058 Right-Of-Way PermitAPPROVLED
RIGHT-OF-WAY PERMIT
PERMIT NI IAARGR• ^Q /A% /L? —Z
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TODAY'S DATE: v1 ESTIMATED DATE OF WORK:
APPLICANT (Person doing the work)
COMPANY:
ADDRESS: �L7-�S S. G �✓Y�o((�S Ll U 3
PHONE: 1%-7r' - 3•7 L4 YEMAIL PERMIT TO: 1hf C,,44Lf Ive t✓ ink, y-,"y) e.vl�'
CUSTOMER: !� t� rl C_� �Ct-fie ti(' 9MA
ADDRESS: l) 1, cc kP sL, nt�k^ (a V_nne I T 1 !fit Li
PHONE:
ADDRESS OF PROJECT: I V7 s 1-) i N-? U
DESCRIPTION OF WORK (check all that apply)
ROAD BORE 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 PUBUC WORKS (BPW) APPROVAL
USE OF HEAVY EQUIPMENT YES NO
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.
BONDING COMPANY: E <
BONDING NUMBER: �XSS1.5�?e1 3S
EXPIRATION DATE:
As applicant for this Right -of -Way Permit, I understand and agree to all of the specifications and
conditions listed on the attached sheet.
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(Appli nt's Siena t e1 [Print KI e1
PERMIT GRANTED BY:
(City
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)
ring Dept.