CN-2011-00479_0001-1.tif j
f DR Form 103
PERMIT I
All correspondence or inquiries relative to this Permit No.: 0-40
permit must refer to permit number shown at right. Date: 2/2812012
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Permit issued to: Goodwill Industries, Inc. Permit term: 12 Months
4805 North 72nd Street
Omaha, NE 68134
Work to be performed: Occupy the right -of -way along US-30 with a 12" Storm Sewer in accordance with the
attached plans and specifications.
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Location: Occupy the right -of -way along the north side beginning at a point 1190' east of the west line of
Section 12, T18N, R1 1E, Washington County, 0' east of Milepost 449 and extends 30' north.
The applicant/permittee is granted permission to accomplish the proposed work subject to the applicable section of our
Type A, A -1, E, Specific Instructions attached hereto,
The applicant/permittee shall notify JoEllen Edgington at (402)695-2634 ext. 209 or P.O. Box 37461, Omaha, NE
68137 -0461 at least 48 hours in advance of the time the applicant/permittee expects to begin work within the limits of
the State's Right -of Way and again immediately after the work has been Completed,
NO TREE, SHRUB OR PLANT ON THE HIGHWAY RIGHT OF WAY SHALL BE TRIMMED, CUT OR ALTERED IN ANY MANNER
WITHOUT ADVANCE APPROVAL OF THE DIRECTOR -STATE ENGINEER.
Restrictions and Specific Instructions:
CALL BEFORE YOU DIG — DIGGERS HOTLINE OF NEBRASKA
Omaha: 344-3565 Statewide: 1- 840 - 331 -6666
The City of Blair must be notified 48 hours in advance to any lane restrictions..
Traffic Control
Performance Guarantee: $2000.00 Bus Chk# 071285 Drawn on First National, Omaha, NE
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This guarantee will be deposited to the credit of the State. Upon satisfactory completion of the work, a warrant will be
issued to the permittee in the amount of the guarantee less any expense incurred by the State.
Voucher and warrant for return of guarantee shall be made payable to: Goodwill Industries
4805 North 72nd Street
Omaha, NE
This permit is issued subject to existing Rules and Regulations of the State of Nebraska, Department of Roads and to the applicable Specific Instructions
and Restrictions attached hereto, and any violations of the Rules and Regulations or Specific Instructions and Restrictions shall cause automatic
revocation of this permit; and any and all improvements made pursuant to this permit may be removed by the Department of Roads at applicant,
permittee or the improvement owner's expense, The applicant, permittee or owner of the Improvement understands that this permit does not confer a
vested right in lands of the public; and where the Department of Roads deems it necessary to improve its highway and right of way, any improvement
constructed on public land by the permittee, applicant or owner of the Improvement will be moved or reconstructed by the permittee, applicant or
improvement owner, successors or assignees at the applicant, pen or improvement owner's expense. The issuance of this permit to perform work
on the public right of way is considered to be issued to the owner of the improvement placed upon the right of way even though such application is made
by the owner's contractor. Additional information may be obtained from our District Engineer, Tim 1Neander of Omaha, NE, or from the permit officer at
1500 Highway 2, Lincoln, Nebraska.
Approved for
State of Nebraska, A art! nt f Roads
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DISTRIBUTION: (PERMITTEE) (ISSUING OFFICE) (CONTROLLER) (DIST, ENG.) (MAINT. SUPT. -FILE)