Transcription of APPLICATION FOR ROADWAY/SIDEWALK PERMIT(S)
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APPLICATION FOR ROADWAY/SIDEWALK PERMIT(S)
Rev. 9/15/10 8. Type of Pavement: a. Roadway_____ b. Sidewalk_____ 10. House No.:_____Permit :22. Date:_____/_____/_____(Authorized Representative of Applicant)Date(Please Print) / / 21. Signed by:_____ No permit shall be issued unless all applicable insurance and permit bonds are on file. 19. Submitted by:_____20. Tel #:(_____)_____-_____(For Official Use Only) SECTION F: Acknowledgements and Agreements by Authorized Representative of the ApplicantApproved for the Commissioner by: The permit to be granted is subject to the following conditions: The applicant agrees to comply with all laws and rules of the Department and any other applicable laws and rules. Additional Fees: Inspection:_____ Tunneling:_____ Other (Specify):_____OCMC Approval by: / / Special Stipulations: permit StipulationsPermit Number SECTION E: permit Stipulations (For Official Use Only)___ 0405 CONSTRUCT NEW sidewalk - BUILDERS PAVEMENT___ Other Type of permit _____ SECTION D: Work Zone Sketch (Include On Street, both Cross Streets, North A)
INSTRUCTIONS FOR COMPLETING ROADWAY/SIDEWALK PERMIT APPLICATION PROPERLY . To ensure the proper processing of your application, please print all information CLEARLY.. SECTION A: Applicant Information
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Application, Permit, Roadway, Sidewalk, CALIFORNIA DEPARTMENT OF TRANSPORTATION, Permit Application, INSTRUCTIONS FOR FILING PLANS, New York City, Sewer Connection and Repair Manual, Philadelphia, Florida Statutes, Orange County, Florida, PUBLICATION 213, WHEREAS, Redevelopment Authority of Prince George