HomeMy WebLinkAbout13020048 Right-of-Way Permit APPROVED
'RIGHT-OF-WAY PERMIT
PERMIT NO: 6)). 52/3-3
Note: Open cuts in pavementrequire Board of Public Works.(BPW) Approval
kDDRESS OF WORK: 3191 ZcJ Avc- "t Ca riNet, I Ai C 60.3
)ESCRIPTION OF WORK (check all that apply):.Road Bore Construction:Entrance
street Cut_Driveway Replacement Lane Closure Road Closure Other
JSE OF HEAVY EQUIPMENT (yes or no): IF YES, TYPE OF HEAVY°EQUIPMENT"(Bobcat or
arger) TOBEUSED: [ CCt Glkc t'cr'bb
/ r'
CODAY'S DATE: 2 i 13 ESTIMATED'DATE';OF WORK: /I/Apc — Sp�tp I• t (.7
CYPE OF SURFACE TO BE CUT (if applicable): 4114
APPLICANT'S NAIVIE (Person doing the work): blur( TEA" �S.Sn Gr Phone: I -Z0Z3
Address: // 32-- .s /Qct"Ad;ne- Road c - t IN 9'60/32-
NHO IS APPLICANT DOING WORK FOR: Name: AR.r•k C' Cc,rpl�.„ WVe,-ft
Address: g. 1 E le\ joy en- loo 4-kvoky Lr4d Pr;Ve Phone:
)RAWING ATTACHED (yes o n ZM J,r. of , TN 4 6 aI of
JOTE: ON REVERSE SIDE OF THIS PERMIT, PROVIDE NAMES AND CONTACTS OF ALL•SUB-
:ONTRACTORS TO BE INVOLVED IN ON-SITE WORK ON THIS PROJECT.
;URETY BOND: Please see-Item #1 of the Right of Way Conditions
3ONDING COMPANY: L; BONDING# 6010 ( 6 61
As applicant for this right-of-way permit, I understand and agree to all the specifications and conditions
listed on the attached sheet. //wwyy
O
(Applicant Signature)
'4,
'ERMIT GRANTEDHY: sue- L
C' Offic`U'9 Date Issued)
REPAI ' WORK INSPECTED AND APPROVED
I have inspected the repair of the above right-of-way and find it to be completely satisfactory.
(City,lnspector). (Date Released)