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Home My WebLink AboutRight of WayR�GHi-OF-WAY PERMIT R�RNiIi fUifM$ER: T�I1AY'S �A7�: �^ , � �`G� EST[MATED DAT� OF W�RK: �f'� � �. (P�rsora daing the vuark} COMAANY: ADDR�SS: PHQN�: CtJST�iV�Eii: ,4pDR£SS: �HONE: ,tt't C li, U w� 1 —�-------- �� '� � �� . '� � '� C ��'�: : ;,i ,- � �.. � 1U � i� L;�::�`� �I �-'�� 'r.a�lta�t % EMA1L �ERM17T�: ��'i�v i �' =r t�L: ' 'r.:��..C',��-i � , �� C� � ' ,� � "�� - `�� , �' � .��..:? �_i �;. �� '�_ ` r ' 4. � 1 � L � I � � ` � � p A��RESS AF Pi20JEC1': � t'�.. �� [3�SCRIPiiOI� �F 1N�R1C (check ali tha� apPiY} ROAD BOR� ❑ QRiVEWAY REPWCEME€V� � �CQh1S`�RUCilDN ENTRANCE ❑ LRiVE CL(75URE ❑ VSTR�ET CIET � R�AD CLOSU�tE C� �OTHER D�SCRIPTION: �TYP� OF SURFRCE CUT {�f applicabie): �� '�NtiT�: aAEN CUiS !� P�VEM�IUiREQUIRE 13�ARfl CJF PUBLl� WORKS (SF�I) ��'PTtOVAL* U5E OF M�AVY EQUIPMEiVT Y�S � �fl � DRAWENG AiiACHED YE5 t�D � l�`(VDTE, ON REV£RSE SII3E QF 1'H4S PEftMiT, PROVID� fiJAM�S AIVD C(3NTACTS �F ALL 5UB-CQPdTRACTOR5 i%1VQLVEE3 BOf�D. Please see Item #i of the Right-of-Way Conditions. BONDING COMPANY; 6�I�C3IIVC NLJMB�R: EX�IRAT[01� DATE: ;� far !' 'rs ght-af-Way Aermrt i undersiand and crgree ta al! of the specifirotions und �• condit�ions listed,p,n the attached sheet. �f ( ��_ � . LiLi�l �iLSr��SC-L{e aiure) {Print i�ame) P£RMfT GRAfVTE4] BY: !C�MMENI'5: pATE ISSUE�: {City Official} REPAIR WDRK fNSPECTED AND APPR011ED I ha�e inspected the re�aEr otthe af�ove rigF�t-of-way and find it to be com�l+?tely 5atis�FaCtQry. {Cfty 4nspector) (Date Re�eased)