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PERMIT EXPIRES 180 DAYS AFTER DATE OF ISSUANCE. RIGHT-OF-WAY PERMIT APPLICATION DESCRIPTION OF WORK: (Mark all applicable) Pavement Cut: Directional Bore: Sewer / Water Connection: Driveway Apron: Sidewalk Replacement: Project Address: Do Not Write in this Space Date Received: Permit #: Date Issued: Drawings Received Perf. Bond Received Liability Ins. Received Indemnity Received Terms & Cond. Signed Contact Name: Contact Phone Number: Village Engineer Public Works Superintendent Name Address Phone Property Owner: General Contractor: Sub-Contractors: Village of Harwood Heights Engineering Department 7300 W. Wilson Avenue, Harwood Heights, IL 60706 (708) 867-7200 1 of 5
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