HomeMy WebLinkAbout13040197 Right-of-Way Permit -_. _. _. ___- -- — I
� \ , q APPROVED
RIGHT.-OF-WAY PERMIT
PERMIT NO: 0 `/a 9/3 -,S
PERMIT ISSUED FOR WORK WITHIN CITY RIGHT-OF-WAY AND/OR,CONSTUCTION ENTRANCE OR
CONSTRUCTION TRAFFIC FROM THE RIGHT-OF-WAY
Note: Open cuts in pav ement,�r'e/quire Board of:Public Works(BPW) Approval/
ADDRESS OF WORK: /4-5-4q avr yr4'/�c - j 104J-c9 tt.0 /j(.1. 4/6077
DESCRIPTION OF WORK (check all that apply): Road Bore Construction Entrance x
Street Cut Driveway Replacement: Lane Closure Road Closure Other
USE OF HEAVY EQUIPMENT (yes or no): 'tS IF YES, TYPE OF HEAVY EQUIPMENT (Bobcat or
larger) TO BE USED:, E XC1v!+'T
� a/--
TODAY'S DATE:" 2--CIl3 ESTIMATED DATE OF WORK: J'r__l
TYPE OF SURFACE TO BE CUT (if applicable):
r3�u��v���"rXXS
APPLICANT'S NAME (Person doing the work): �g ?Wi7t4t6 Phone: it'7) 7/91---/t8 3/
Address: /2. 0 . 60X S'l Z. LE7maia,3 a vec -Z
WHO IS APPLICANT DOING WORK FOR: Name: �Ke Sou/.._S
Address: //.i /9 � Y* /2. Phone: (76s-) .71.-- 7274Z.
DRAWING ATTACHED (yes or no) YC5
NOTE: ON REVERSE SIDE OF THIS PERMIT, PROVIDE NAMES AND CONTACTS OF ALL SUB-
CONTRACTORS TO BE INVOLVED IN ON-SITE WORK ONTHIS PROJECT.
SURETY BOND: Please see Item•#1 of the Right,of Way Conditions
BONDING COMPANY: rr "' BONDING#
As applicant for this right-of-way permit, I understand and a II the specifications and conditions
listed on the attached sheet., / , 174-G
(Applicant's,Signature)
PERMIT GRANTED BY: le ■ - `' 3
'ity Off fe 1s: ed)
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)