HomeMy WebLinkAbout1976-09-01 Hennepin Co Application for Permitr AMIAL CWSTRUCTIOM . Uhmit pclnt •howing ffp% mni I.Mflon o9 Inttallgtlgu.
3. UNDERGROUND COMSTRUCTIOM
CONDUIT INSTALLATION
□ Multi duct tilu P!p« clots
□ Trontito Typo boddtog.
□ Cloy or concroto Sorvico typo _________________
□ Stool, cost or plastic Siso Ti/C**_________
OtHor______________________________ Dopth ___________
4. METHOD OF INSTALLING UNDER ROADBEDS (If opon troocK osplolfi «rky nocossory)
Q Soring □ Jodiing □ Opon trondi
AREA TO BE DISTURBED
Ig.4LYgLEDSURFA«
Q Concroto
□ Bituminous
Othor _____________
w SHOULDER
□ Bituminous
□ Grouol
Othor _____
I BOULEVARD
□ Sod
□ Fiold Gross
Othor. travel
STRUCTURES
□ Bridge
□ Bom culvort
□ Pipo (Concroto, metoi)
Q Curb B Gutter
□ Sidowolk
Othor________
□ Trees
□ Shrubs
Q Plontings
W'
6. The surfoco will bo restored ond oil work under this permit will bo completed on or before __ i ecc!!!»>or 31^ l‘>76
(PERMIT IS VOID AFTER TNIS DATE)
If work connet bo completed within dotes specified, o written request for permission of estensien must bo ssodo to the Hennepin
County Highwoy'Deportment.
EMcept for the negligent octs of the County, its ogents and its employees, the Utility or Permittee shell assume oil liobillty for ond
save the County, its ogents and its employees, harmless from any ond oil claims for domoges, octiens or couses of octien arising
out of the work to be done herein ond the continuing uses by the Permittee, including but not limited to the placing, constructing*
reconstructing, mointoining ond using of sold utility under this opplicotion ond Permit for construction.
(I, We) the undersigned, herewith occept the terms ond cortditions of the regulations os laid down by the County of Hennepin or»d
ogiee to fully comply therewith to the sotisfoction of the County Highwoy Deportment.
Orgonisotion .Ml (XS CQMIXIY
J.:i. Aritjerson, Oiief ’’ni:inecr