ROW (11)WASHINGTON
Internal Documentation
Permit M *
2023.0371.ST0016
Receipt#:
Amount Received:
$ 0.00
Application
Plans: * (')
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Description of Work:*
Three of our dry dry ponds catch basin needing cleaning out
Also all maintenance in our neighborhood storm water
Also maintenance fixing and repairing the grates
Location of Work*
Nisqually meadows yelm wa 98597
Right of Way Access or Work?*
I ONLY need ACCESS to the right of way
I will be working IN the right of way
Road Cuts?
I Will be cutting the road 0-50 Sq ft
I Will be cutting the road 101-200 Sq ft
I Will be cutting the road 301-400 Sq ft
Estimated Cost
$ 125.00
Name & Contact Info
First Name* Last Name*
Elena Pilor
Address*
Street Address
10435 Brighton st se yelm wa
Address Line 2
City
Yelm
Postal / Zip Code
98597
Proposed Starting Date of Installation*
5/20/2023
Duration of work in Days/Weeks*
10 days
Applicant Agreement*
I have read the above Application Requirements.
I Agree
Signature
4
f'
Phone*
3604855479
Date *
5/20/2023
I Will be cutting the road 51-100 Sq ft
I Will be cutting the road 201-300 Sq ft
Email *
elena.pilor@icloud.c
om
State / Province / Region
Washington
Country
USA
Agreement
GENERAL PROVISIONS APPLICABLE TO ALL PERMITS
In accepting this permit, the petitioner, his successor and assigns, agree to protect the CITY OF YELM, WASHINGTON,
and save it harmless from all claims, actions or damages of every kind and description which may accrue to or be suffered
by any person, or persons, corporation or property by reason of the performance of any such work, character of materials
used or manner of installation, maintenance and operation or by the improper occupancy or rights of way or public
structure and in case of any suit or action is brought against said City for damages arising out of or by reason of any
commencement of such action, defend the same at his or their sole cost and expense and will satisfy any judgment after
the said suit or action shall have finally been determined if adverse to the said City.
If the work done under this permit interferes in any way with the drainage of the area, the grantee shall wholly and at his
own expense make such provisions as the City may direct to correct said drainage problems.
Upon completion of said work herein contemplated, all rubbish and debris shall be immediately removed and from the
roadway and roadside shall be left in a neat and presentable condition that is satisfactory to the City.
The party or parties to whom this permit is issued shall maintain at his or their sole expense the structure or object for
which this permit is granted in a condition satisfactory to the CITY OF YELM.
The CITY OF YELM may revoke, annul, change, amend, amplify, or terminate this permit or any of the conditions herein
enumerated if grantee fails to comply with any or all of its provisions, requirements or regulations as herein set forth or thru
willful or unreasonable neglect, fails to heed or comply with notices given or if the utility herein granted is not installed,
operated, and maintained in conformity herewith or at all or for any cause or reason whatsoever.
All work areas shall be adequately barricaded according to MUTCD Standards. Barriers shall be properly lighted at night.
All trenches shall be backfilled with selected backfill materials unless otherwise directed by the Engineer.
PAVEMENT REPLACEMENT: Asphalt pavement shall be replaced to a minimum depth of four (4) inches thick or match to
the existing pavement whichever depth is greater and to the dimensions specified by the Engineer. In gravel alleys the
permittee shall replace base and surface rock.
All work shall be conducted using current WISHA/OSHA regulations. Particular attention shall be paid to the requirements
as they pertain to work in trenches, electrical work, work in high places and to safety apparel such as, hard hats and safety
vests.
All work shall be completed to City Standards as set forth in the City of Yelm Development Guidelines, and policies. The
PUBLIC WORKS DEPARTMENT office (360-458-8406) must be contacted for inspections 24 hours before work
commences.
General Provisions:*
I Have read and Agree to the above terms.
I understand the Public Works Department (360-458-8406) must be contacted for inspection 24 hours before work
commences or this permit will be void.*
I Understand
I understand the Underground Utilities Coordinating Council (1-800-424-5555) must be contacted two (2) working
days before proceeding with any excavation associated with this permit.*
I Understand