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00 City of South Bend Pubic Worla Phone. 574.235-9251 <br />Emal- dhansonQsou1hbend)n.gov <br />AW W, JEffemon, covr4y City 130drs 1216 <br />Zamih E-mnd. M 46601-ISW <br />EXCAVA77ON FEWWrWOUEST <br />Date Submitted. November 27,2018 <br />Instructions- 1) Print Clecuiy 2) Complete Al Sections <br />Submit 11 It* Form In Person 2� Or Email To- <br />%3) Upon Permit approval. Sign issued permit and Retum <br />6W*M.mgwzwwmmmsus��� Ez� �- <br />Applicant Woodruff & Sons, Inc. <br />(Contratiot/Company Narne) <br />Contact Name Emal brucew@woodruffandsons.com <br />Phone Number 219-872-8605 <br />Street Addrew I Location of j%fork 2125 E. US Highway 12, Michigan City, IN 46360 <br />Type of Work Ca b;e Eilecl6c Feber Gas Manhoile repair <br />Sanitary Sewer Water Other <br />TypS pf Cy 0 cuts Bonng Trenching (open) # Feet <br />Cut tocation In Street Outside curb, but in treelawn/ddewdk, Right of W13y <br />Comments I Description of Work Date I Dtffation of ptojec-4 (eg::2/1 Ila. 2 M) <br />Excavation! in ROW without a peirn-di, virill result fn stop w<•mk ordej and/of delays in pefmithing. <br />Applicant S$qnatiAe <br />R •F <br />-4 1 <br />EXCELLENCE —' ACCOUNTABILITY —1 INNOVATION + INCLUSION + EMPOWERMENT <br />Version 7/20/2018 Contractor's Bid for Public Works- 12 <br />