HomeMy WebLinkAbout2007-05-02 MNDOT Utility Install Permit' DISTRIBUTION
Original to Arm ►mote ra E a g ;
Applicant
Subarea Supervisor
R.oadwamy Micro SUparvi or
r
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DEPOSIT REQuiREKENTs
0 No Deposit sit l uited
0 Deposit Required in tbo Amount of $ '
DEPOSIT TYPE
. a ier's b e g
Certified Chic il,,,,,,, _ ......._ . .
Marmy Qrdar U
lidc 1kpoTii Iteccived 1
Deposit to be yowled upon utisfootory complaion of all work
Bond 0
DATE WORK COMPLETED
_ _ - - he dale when the work is eo oleid mug ft reported to toed r/DOTJi!oadww R mf r s a r endwr.
+ii' DOS 'T' -1723 (IUOftTFORM fisFultt' (a » ), 3 j9 {- -- ;sari
MINNESOTA DEPARTMENT OF TRANSPORTATION
cs- tr TH. 6
APPLICATION FOR INSTALLATION OF UTILITIES - , -
OR MISCELLANEOUS ' TRUNK HIGHWAY or
RIGHT OF WAY
.. .TA , ASKETCH OF THEPROPOSED - WORK AArD RELATION TO TRUNK HIGHWAY. SUCH SICETCH SHALL BE-DRAWN TTO ..... -. _ ......
SCALE WHEW REQUIR.ED By THE ENGINEER. PRINT OR TYPE PP I ION: SIGN IN SPACE PROVIDED.. SaniSfir TO LOCAL
OFFICE OF TEE MIArNESOTA DEPARTMENT F TRAArSPORTATION.
APPLICANT
Manley Commercial Inc (651) 286
PARTY PERFORMING ORK
Manley Commercial Ina ; (651) 28S-5'2493
LOCATION OF PROPOSED WORK
Highway . 36 . i Oak Perk Height ci x 4, WashiVon
MATURE of WORK Grading, Sanitary Serer Service and Watermain Connection
ion
DEPTH OF EWA VAUON BELOW SURFACE
Maximum of 15 It
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NUMBER & SIZE OF EXCAVATIONS
ft' lyaa►rcrxirrraely 15 by 20 ft
WORK TO START ON OR AhR WORK TO BE 91,1v1PLETILD ON OR BEFORE IS'TRAFFIC DETOUR NECESSARY9
no
M9 5, 2007 . tl
1, We, the undersigned, herewith apt the terms and conditions of the
wit ttquirernents of the Commissioner of Transportation and agree to
filly comply therewith to the satisfaction of the Minmota Department of
Ttansportation. It is agreed that no work in connection with this
application will be started until the application is approved and the exit
issued. it is further understood that this permit is issued subject to the
approval of local city, village or borough authorities having joint
supervision over said stmt or highway and subject to appiiCant's
compliance with the rules and regulations of the Minnesota Environmental
Quality Boat and any other affected govennnental agencies.
Furthermore, except for negligent acts of the Mate, its agents and
employes the applicant or his agents or contractor shall assume all
liability for, and save the State, its agents and employees, !mirthless from,
Date MI Work To Be Completed by
EC ICIT
4
MAY 0 7 2007 Jjj
fLEMNE ADDRESS (Soup. City, State, zip)
TELEPIIONE ADDRESS (Stmt, City, State, Zip)
Dated
By
Page € of
Coumy
Signature
DO NOT WiarE BMW THIS ONE
SEE ATTACHED SPECIAL PROVISIONS
2040 Eagan Woods Drive, Sulte 220, Eagan , MN 55121
R P.
(DO NOT CMP TH THIS SECTION - FOR OFFICE usE CNL
2640 Eagan Woods Drive, Sine 220 Eagan, MN 55121
mil. East or Noire, Ave
't�l4i • tJ"1
(SPECIFY R l INTERSECTION O R LANDM ARK)
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SURFACE TO BE DISTURBED (Check Appioprinte Boxes)
1...htoadwayLiShouldet Tbzoitactc ; : itun iaro«s t _!Gravel
x o f cr D t a #urrr and Rack Sloes
SOD OP INSTALLATION/CONSTRUCTION
Open Cut
YES, TRAFFIC CONTROL PLAN IS REQUIRED)
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Ku r-� M;i .. Is
W inne —P i Typo
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any and all claims for damages, actions or causes of action arising out of the
work #a be done herein and the continuing usage, constructing,
reconstructing, maintaining and using of said utility/misoallaneous work
under this application and permit for construction.
'E PERMIT T ill LFS r S Ci - t E E SIDE FO LJ i� I3 AL
t RJN SIG 'A E A 1D UMBF A T . LZA I F PER M T Ih FORMATION AND i c JIR ENT
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It is expressly nnderst d that this permit is conditional upon replacement or restoration of the trunk highway to its original condition or to a satisfactory condition In
consideration of the applicants agreement to comply in ail =pets with the reguiatioas of the Commissioner of Transportation covering such operations, pet mission is
hereby granted for the work to be performed as described in the above application, said work to be performed in a eordattce with special provisions as hereby stated.
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