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APPLICATION TO USE THE PUBLIC RIGHT OF WAY
APPLICANT INFORMATION
LEGAL NAME OF ENTITY: /V\nj J~r*irt j./tt/SS.'grl C& X«C.
PERMIT MAILING ADDRESS : ty/SJ UA 6> S&wJ AoC._
CITY .Ch.'Cnja_STATE ZIP CODE: GOtoS* I
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Public WiyUuUnlt
C(i»toirnrS«rrtw Ctnttr
333 S. Sale StKet, Snllc LUO
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(3 I2)744>0MZ (7444249) (3l2)74tl974rTTY)
CONTACT PERSON: "Teg. ?e.rft,TTct TITLE <Ct»Jn»J» / L*i« Se. I
PHONE: FAX: Q>5Q~$& 'k&^MAlL: J p<y>ejyo tT* &. YoLmU**,
USE OF THE PUBLIC WAY
1. List the proposed or existing use below and complete the attached worksheet. Only use one application per public way use type.
Type
Si.
How many?
Building Address
2. Please enclose one sketch of proposed use of the public way. which maps to scale
the proposed use and its relationship to surrounding right-of-way. All measurements must be
indicated.
The prints should also accurately depict the location of the property line and public facilities ( meters, light poles, sidewalks).
APPLICANT CERTIFICATION:
1 hereby certify that all statements made as part of the application and tbe attachments herein, and true to the best of knowledge and belief.
Bv:
.Title: Ls»j«itt.l
F.E.I.N. or Social Security Number:
ALDERMAN'S APPROVAL:
As part of this application process, you are required to notify/obtain approval from the Alderman in whose ward your proposed use ofthe public way is located.
■<B^*i^---^ WARD 3>* PATE
ALDERMAN'S SKSNATtt