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HomeMy WebLinkAboutRight-of-Way Permit App 11-19-19�i���-o�-wav ���Mi� PERMiT NUMBER: TQ�AY'S DATE: �.� '� ,� "� G �STi�'vl:��CD DATE C?F WaRK: APPLI�ANT �Person dving #he work�.,�,� DE. �F' L�� �� . iCflMPAIUY_ [ADi]R�55: PNo�v �: �tJ57QME� ADDRE55: ��aa��: �_ I r ��V t I `I • ��a�F �z �5 Vft�� (13���3�-��� y ElvlAiL PEitM1T��: ��1��7 1I1�1,C.����Cort�r 1.��rA� N I� r.+��1f�t9 �c � � �- �3 rz � 71 c, -- 'T� �� , .� RE55 �F FRi3]fCT: � �C.v � � C�L `7P tr-�' /l�"�� � �. :RIPTION C]F WQRK [cheek a!i t�at appfyj 7 BQRE �._ � ORIVEWAY Rf�'LACEM�N'� � 5��it1C'�I�IV EN��2ANCE i�`1 �ANE Cl,i35ttRE � E7 CUT RDAD CZ�SLJRE �' _R � RIPTIQIV: �F i�"C.� �� � �I.►-?��.�.1 OF 5t1Ft�ACE CiJ7 tif appiica6le]: /�i�/} *N�TE: DPFN CP,ITS �N FAVEMENF RFQt11RE B��4RLi QF PU8C1C Wt}RK5 �BPLV) APPl7�VAL * U5E 4F �#EAVY EC�UfPMENi YE5 � NO �'C. tiRAWING AT1'ACH�B YES � NO � •h107E: ON REVERSE SiDE QF 7Hi5 �ERNFiT, PR�VIDE l4AME5 AN� £b!'+17AL�5 O� A�� SLIB-L�H�RACiDRS lNVaLVE❑ B�Ni). Alease see item #1 of the Right-vf-VYay Cor+ditic��s. sor��itv� conn�an�v: SC3i�61�IG NUiVIBER: EXPIRATlQN �1a�E: �SE� +�`�Tl� As a�pltrant far thrs Right-af-Woy Permi[ 1 unders[and and agree to a11 of the specifrcr�[ians Qnd candifrnns lisr d on the a[[ ched sheet. � O � i/1 � fA�� n£'s Signa urej (Prinl NameJ Gi�ANTED BY: CQM M��3T5: (City OFficial� Q��E fS5iJED: l�EPAiit 1Ai'QF�K lPIS��CT�� ANl7 APP3i0VEi3 t ha�e inspected the repair of the ahn�e rig#�t-of-way and find it ta he campleteiy satisfartary_ � (�ity inspe[ior} ti3ate Releasedj