HomeMy WebLinkAbout19080142 Right Of Way Permittlu Vz Lj
CITY OF CARMEL RIGHT-OF-WAY PERMIT
PERMIT NUMBER: 0Y 23 /G% _,
TODAY'S DATE: j f I g � (� ESTIMATED DATE OF WORK:
APPLICANT (Person doing the work) 1Zn_CkJ_LA
Carmel Engineering, Reps.
COMPANY:
ADDRESS:
PHONE: at-1 _ -7 � EMAIL PERMIT TO: r, ,gyp ShP� (� � (J Vr 0. corn
CUSTOMER:
ADDRESS:
PHONE: t tR_ Rqq e
ADDRESS OF PROJECT: ( 0-Sl ` I A
DESCRIPTION OF WORK (check all that apply)
ROAD BORE ❑ DRIVEWAY REPLACEMENT ❑
CONSTRUCTION ENTRANCE ❑ LANE CLOSURE ❑
STREET CUT ❑ ROAD CLOSURE ❑
OTHER
DESCRIPTION:
OF SURFACE CUT (if applicable):
*NOTE. OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW) APPROVAL
USE OF HEAVY EQUIPMENT YES [3 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: o-�
BONDING NUMBER: a I )
EXPIRATION DATE:
As applicant for this Right-af--Way Permit, I understand and agree to all of the specifications and
conditions listed on the attached sheet.
L,� �.
(Applicant's Signature) (Print
Name)
PERMIT GRANTED BY: DATE ISSUED:
COMMENTS:
cial)
/ 9/Z/O
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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