Ord 1987-146 - Laserfiche WebLink

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PUBLIC RIGHT-OF-WAY CONSTRUCTION PERMIT Date: / / Permit Application No.: Company/Owner: Address Applicant Address Phone: Phone: Contractor Address Phone: Plans Submitted: Applicant's Signature: City Acknowledgment: (yes) (no) Date: Date: / / / / / / Data: FOR CITY USE, ONLY FEES: 3. 4. 5. 6. Right-of-Way Construction Permit Pavement Repairs: a. Flexible Base & Asphalt Pavement b. Concrete Pavement c. Asphalt Surface d. Miscellaneous Repairs Backfill of Trenches Clean-Up of Area Street Sweeping/Flushing Inspection Fees: a. Minimum Fee b. Pavement Repair (10 s.y. or less) c. Pavement Repair (greater than 10 s.y.) $ 1. 2. TOTAL FEES DUE $ APPROVED: Superintendent of Public Works: Superintendent of Water/Wastewater: Director of Environment and Engineering: Director of Public Works: Date: / / Date: - /- /- Date: - /- /- Date: / / FINANCE: Cashier: Account: Receipt Number: Date: _/_/- NOT ICE In consideration of the granting of this permit, the owner/company making this application agrees to indemnify and hold harmless the City of San Marcos, Texas, its successors, assigns, agents, officers, and employees, from all damages, claims, losses, demands, suits, judgments, costs and expenses arising directly or indirectly from the conduct by the owner/company, its successors, assigns, agents, subagents, and employees in connection with this permit. I cert! fy that I have read and examined this application and know the same to be true and correct. All laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. (Signature of Contractor or Authorized Agent) (Date) (Signature of Owner, if Owner/Builder) (Date) (Printed Name) (Printed Name)