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rx� <br />DEPARTMENT OF PUBLIC WORKS <br />Excavation Permit No.: 3920 <br />Date Issued 5/27/2020 Contractor Name Clarkco, Inc <br />Excav Exp 6/26/2020 Contractor Phone 574-862-4323 <br />Address <br />2124 McKiniey Avenue <br />Connection Type Sanitary Sewer Inspector Name Lon fe� ll -v <br />Size of Cut Unk Inspector Phone (574) 286-9589 <br />Issuer LAH <br />Comments Ingaall w r to new Mgrgdhona ui in <br />OFFICE OF THE CITY ENGINEER, South Bend, Indiana certifies that the above contractor, having an <br />approved excavation bond on file with the Board of Public Works is granted a permit to excavate into the <br />City Right of Way in front of the above address. Said work to be performed under Provisions of the South <br />Bend Municipal Code Chapter 18, the current Department of Public Works Design and Construction <br />Standards, and the Department of Public Works Prevailing. Specifications. <br />THIS EXCAVATION PERMIT IS NON -TRANSFERABLE AND ITS ISSUANCE SUBJECTS THE NAMED <br />CONTRACTORIPERMITTEE TO ALL APPLICABLE RULES, DUTIES AND OBLIGATIONS IMPOSED BY <br />THE CITY OF SOUTH BEND MUNICIPAL CODE AND TO ALL REGULATIONS IMPOSED BY THE <br />SOUTH BEND BOARD OF PUBLIC WORKS. <br />VOID IF CONTRACTOR HAS NOT STARTED WITHIN 180 DAYS —CONTRACTOR IS TO CALL <br />INSPECTOR FOR INSPECTIONS 24 HOURS PRIOR TO EXCAVATIONf1' <br />Location: Outside Roadway <br />No. of Cuts: <br />Amount Due: Contractor signature <br />Payment Type: InviC <br />Paid by Check No. Printed Name ._. <br />