HomeMy WebLinkAboutRutledge St ROW Permit ._ ;
EXHIBIT "C"
Jvc� .� oy- r�fq-P
PERMIT
TO WORK WITHIN CITY PROPERTY/RIGHT-OF-WAY/EASEMENTS
AND
APPLICATION FOR INSTALLATION OF UTILITIES
i . Location RU7'LEDlrE sr�Er PRDJIL7' � I T�l �RDS E�T
IeELOLATE PffONE G46LL'S /�3 NEEDLD
2. Nature of Work �� p�'�E NEU/ G46LL FDa FuTUKE DEr/ELDPMEA/T'
3. In3icate below items to be affected and include a sketch ar plan of work to be done.
Curb & Gutter Street Surface
TraiUSidewallc Trees:
Pond/Wetlands (Publically owned
Traffic Control Devices/Signs or Privately owned �)
Drainage Utilities
Structure/Buildings Other 6LVD `
4. Method of Installation or Construction e��E 0�. V�6QATi7ItY P�pW '
5. Work to start on or after: �P��L 19,- IJy �d shall be completed by: NDU 3U, • D5► unless an extension
granted to• by:
DATE STAFF/DATE
6. Will detouring of traffic be necessary? nV If necessary to detour traffic, describe suggested
route:
7. Provide with this application a copy of the contractors Public Liability Insurance.
DETOURS: The Director of Public Works shall be notified in writing at (east 72 ho�rs in advance of
any detour being established, changed or discontinued.
NAME OF APPLICANT 2��E�'RA T�L.E.�.OYY\. pHp� 952-447-3758
PLEASE PRINT FAX qSZ-22fo •37 �S
ADDRESS 4�q0 CCLpRADa St. 5.�. YR1o'IL L,I�K� MN. �3
STREET CITY STATE ZIP
NAME OF PARTY OR ORGANIZATION PERFORMING WORK
CONTACT PERSON: aARLRC��. EMERGENCY (24 HR.) PHONE #:4S2•22.(0-70�04 V.fYI. k YRGE
ADDRESS`�690 CoLDRRDO St. S�E. VR��R LRkL MN SS372DAYPHONE �12'9�°►-588� C��- #
STREET CITY STATE ZIP N O M� 952 • 4fo 1- 3l i 4_
The undersigned �herewith accepts the terms and conditions of this permit by the City of Prior Lake as herein
cont an ee to fully comply therewith to the satisfaction of the City of Prior Lake.
Signed: Title �G��t��� Date: �� t Z-b�
. 79
r
EXHIBIT "C"
FOR CITY USE ONLY AUTHORIZATION OF PERMIT
FINANCIAL SECURITY: � AMOUNT: '� � TYPE:
(Cash, bond, LOC etc.)
Fee: $ 1v � Receipt No. Permit No. �—� d/
LIABILITY INSURANCE PROVIDED 3RATR�O IyJlD1�LET4J✓ INSURANCE
In consideration of agreement to comply in all respects with the regulations of the City of Prior Lake covering such
operations, and pursuant to authorization duly given by said City of Prior Lake; permission is hereby granted for the
work to be done as described in the above Application, sAid work to be done in accordance with special provisions as
hereby stated:
C'oo�2�irv��E c,��� �i�/ �/1o�Ec� �#D —//
. APPROVED BY: DEAT. OF PUBLIC WORKS
By: °�� �' 3-/��
. /DATE
ALL LEGAL REQUIREMENTS SHOWN ON PAGE ONE (1) AND ON ALL "SPECIAL PROVISIONS" SHALL
BE COMPLIED WITH. THE DATE WHEN WORK IS COMPLETED MUST BE REPORTED TO THE CITY
OF PILIO� LAKE CITY ENGINEER. • " •�•
. . _ ".o . �• ,
80
.
UTILITY LOCATIONS ARE APPROXIMATE ONLY
EXACT LOCATIONS SHALL BE DETERMINED W
THE FIELD. MAP IS FOR VISUAL PURPOSES,
ONLY. ALL LINES ARE APPROXIMATE.
LEGEND
-��� � . N
— � � — FlBEROPTIC GBLE
— SUBSCRIBER CABIE
• TELEPHONE PEDESTAL
� FUVJDHOIE
BJF 75-24 CABLE SIZE
� WOOD POIE
— LOT UNE �
NO SCALE
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PRIOR LAKE � PRIOR LAKE
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