2014-16C ROW Permit 09292014 2014-16
r ._qty of Yelm Perim— No.
PUBLIC WORKS
Rhoton Rd NW Application e o
Yelm,WA 98597 Public Right of Way Connect
Phone: 360-458-8406 iii s
FAX: 360-458-
APPLICATION
The undersigned hereby makes to trench &bore 69' and run undeiotMnd conduct from -Xis tcn
then lace anew"under round v
ped location in p _ vault in before trenching/boring cntorivate.
Location of work: 1202 E Yel
... .... ....�...��.----- -- -:_:-- -
elm Ave _�.m._... .. _ .�.. .. �........
f in strict compliance.. with Yelm Municipal Code, the special condition_. rated
I agree to perform the work in strict s enumerated
herein and the attached conditions I have read and will adhere to the general provisions applicable to permits
contained on this form.
-----
tltl
..
The Public Works Department(360-458-8406) must be contacted r in on rs before work
commences or thi be
void- _
The Underground Utilities Coordinating Council (1-800-424-5555) must be contacted two (2) working days °°-
g,with any excavation associated with this��e ,iijt
e...o.re..ltat �wr: we .........� ° ..r ..... .--- ... m.....
Name: Steve Harshfield
Address: c v 'n",er"'
r, Phone
f - / Duration:
.Pro .... --
Date: 9/29/14
f. YT _ w
I+sl�MIT I EQUIIII ENTS
For
Receipt Number ..e_� _ ....._.. Applica n A- r... _... ._ . ...._.. -4..u..._. . ........
pp oval ��
..mm.....P.� - �..._ .._��....... . . � ..1 1MAM
°°w..._�._ _..... .. -. ... m ... To Be..Lctleted II �t.�. _
Permission is hereby granted to perform the above described work subject to t L +
eral provisions contained
on this form, and the followi n special
eci ....... ---..w._..... ._.�. _... _
A-bond. _... _ _...... ....� ..... —_wwwwwww..... ._......... .�.... ....._.._.wa._ �..�-...�� �� .....m.... ..
in the amount of.. is required to insure compliance with the above
-._.�_..._._ .._, _.. o stcsfcto co letco of work
conditions, refundablee.0 . ,satin. _.. � .. . m.. ,,.. ��,u °�. __...� �.� �
No work shall be done under this permit until the party or parties to whom it is granted shall have °°° _°�°°-°° °°°° °
co.�o�mmunicat-ed. with received instructions.instr�u..,,c...tion.s. f°rom°:
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First Inspection -� ° _ ° n spectorFinalProlect._ .�. .. . _..- ,.,�.. ,
ate.
Date: Corny tron Approval „
Revised 03109/2011
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