HomeMy WebLinkAboutRight-of-Way Permit ApplicationCITY OF CARMEL RIGHT-OF-WAY PERMIT
PERMIT NUMBER:
DATE: 1D� 'T / 1� ESTIMATED DATE OF WORK:
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311-823-9'788 EMAILPERMITTO: StGdGp,V1055MOJN�iS.
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',IPTION OF WORK (check all that apply)
BORE � DRIVEWAYREPLQCEMENT ❑
-RUCTIONENTRANCE [� LANECLOSURE Q
lCUT � ROA�CLOSURE �
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IPTION: (�'�JgA M�JL �v7� �� AN C�Xl�T1v�1 I���1d
)F SURFACE NT (if appli<able):
•NOTE: OPEN CUTS IN PAVEMENT R1EQUIRE BOARD OF PUBLIC WORKS (BPWJ APPFOVAL*
USE OF HEAVY EQUIPMENT VES Ivl NO e
DRAWINGATTACHED VES LJ NO
•NOTE:ON REVERSE SIDE OF THIS PERMIT, PROVIDE NAMES AND CONTACTS Of ALLSUB-CONTRARORS INVOLVED
SUREfY BOND. Please see Item #1 of the Right-of-Way Conditions.
BONDING COMPANV:
BONDING Nl1MBER:
EXPIRATION DATE:
nt for this Right-of-Woy Permit, I understand and agree to all of the specifimtions and
/ conditions listed on the a[[achedsheet. �
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PERMIT GRANTED BY: DATE ISSUED:
(City Official)
REPAIR WORK INSPERED AND APPROVED
I have inspected the repair of ihe above right-of-way and find it to 6e completely satisfactory.
M
(City Inspector) (Date Released)
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