HomeMy WebLinkAboutRight Of Way PermitCITY OF CARMEL RIGHT-QF-WAY PERMIT
PERMIT NUMBER: l Z % -/Z
TODAY'S DATE: AL4t ! I ESTIMATED DATE OF WORK:
APPLICANT (Person doing the work) �laW-/t, 1:�00&A G
COMPANY: _ W ILLIA,4f
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ADDRESS: Z 3 �l l�-.FFiF ,Sr c-ZZA�rZ L16 032
PHONE: ,{ EMAIL PERMIT TO: 11��LL1l��o 1312()SI()SCG�Y64/l-C
CUSTOMER: CQ�(�C(���-t�`1� � C(WIC' C�L�` G- 3zszLjjr
ADDRESS: 11Z O N. Z4-�6.ELI A� /Zf%).
PHONE: 31:7 — 5--01 - Z .S_ 7 S
ADDRESS OF PROJECT: y� � �L�il� /Z6 . �(
DESCRIPTION OF WORK (check all that apply)
ROAD BORE ❑ DRIVEWAY REPLACEMENT L]
CONSTRUCTION ENTRANCE ❑ LANE CLOSURE ❑
STREET CUT ❑ ROAD CLOSURE ❑
OTHER
DESCRIPTION: 5144L A-UMCAJ 77!1� iCL�-G�(c 1JC�lY
TYPE OF SURFACE CUT (if applicable): O K aP7
*NOTE: OPEN CUTS IN PAVEMENT REQUIRE BOARD OF PUBLIC WORKS (BPW) APPROVAL
USE OF HEAVY EQUIPMENT YES NO
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DRAWING ATTACHED YES NO rj
*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. I,C-OfA
BONDING COMPANY: J
BONDING NUMBER:
EXPIRATION DATE:
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As applicant for this Right -of -Way Permit, I understand and agree to all of the specifications and
Lw,z_/P,4conditions listed on the attached sheet.
WILL64,q C. r S f US
(Applicant's Signature) (Print Name)
PERMIT GRANTED BY:
COMMENTS:
DATE ISSUED:
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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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