HomeMy WebLinkAboutRight of way permitAD
5 PROVED
RIGHT-OF-WAY PERMIT
PERMIT NUMBER: C111
_ ^rigineering Dept.
TODAY'S DATE: /G'%/ar/9 ESTIMATED DATE OF WORK: /Q//Y//q
APPLICANT (Person doing the work)�0.0( r _�
COMPANY: /MofN!a 6G^ trf�uQ
ADDRESS: /f.71. %Gkv.,o L+� q69U�,
PHONE: 2GK77— D EMAIL PERMIT TO: 6. A �i9cco„Sf�Ct,co.,•�
CUSTOMER: t M e- &u T✓c�. a`c �- d_ %' arrc��{t;:..
ADDRESS: /��S �cn�ra Farb r E
PHONE:!
ADDRESS OF PROJECT: f/112s ���r ,, � j`ar� Q� L✓ .�C�ni �C63 Z
DESCRIPTION OF WORK (check all that apply)
ROAD BORE E DRIVEWAY REPLACEMENT
CONSTRUCTION ENTRANCE C LANE CLOSURE C
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 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: AI-4 _ ��,(� /tif�tf.Aa l �n rcl t t.t Cc•
BONDING NUMBER: iQO /01 Sys/
EXPIRATION DATE: ac t.Y Z07�0
As applicant for this Right-cf-Way Permit, I understand and agree to all of the specifications and
�•__ f` , conditions listed on the attached sheet.
(Applicant's SigaawrIeT (Print Name)
PERMIT GRANTED BY: DATE ISSUED:
COMMENTS:
(City Official)
�/Ai" n
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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