Laserfiche WebLink
1 <br /> APPLICATION FOR °IPE LINE PERIVFIT �BURIJNGfON <br /> � NORTHERN <br /> To BURLINGTON NORTHERN INC. Date y� J �y��, ^ <br /> 1 <br /> 1, At what City or Village is permit desired7 ��E�E f� <br /> 2. Full name and ad�iress of Applicant �/�i G'F i'L%%I�/"i "" ����f���L� WJ�1l=� <br /> 3:1UL' Cc/i//L .Ci� �E i/C/L/_`�ii Gv�9 . ___ <br /> 3. If Appticant is a corpore[ion, in what state incorporated? ���'�1��i����� "`� <br /> If an individuai, under what firm name is business conducted� <br /> If partnership, give name of ail partners <br /> 4. Product to be handled in pipe line ����/� <br /> 5. Pipe Data: CARR�ER PIPE CASING PIPE CARRIER PIPE CASING PIPE <br /> a. Outside diameter —g �� �`P� f. Actual wurking pressure <br /> b. Inside diameter �" �r�� g. Type of joint %f'l��N /���` "�'�L `'�«v��� <br /> c. Pipe marerial �'i����t ���^� '�r�"�'�' h. Coating <br /> d. Specifica[ions i. Methodof installation ���'�e �^' ui��y <br /> and grade j. Will cathodic protection <br /> e. Wall thickness n�'��" . �' /'L be providedl "�`'� '�`"`r— <br /> �� <br /> 6. a. Depth of pipe under track (top of tie to bottom of casing) � <br /> b. Angle of crossing ���, < <br /> 7. if pipe is to be placed longitudinally wi[h track,9ive / <br /> a. �ocation of pipe in rela[ion [o centerline of nearest track <br /> b. depth of coverage (ground line to rop of pipe) <br /> 8. If installation is to be by jacking or boring method give location of jacking ano rcceiving pits <br /> a. Depth <br /> b. Distance facing wall of pit to centerline of nearest treck (measured normal) <br /> 9. Reference plans (to 6e forwarded with origina�application) <br /> a. Drawing Num6er b.Prepared by <br /> Applicant agrees that i/ installafion requires any or all ol the fol%wing work; removal and ieplacement of track, bridging, <br /> protection of track or other railway tacilities by worA o�1/agging,engineering and/o�supervision;such work is to be perlormed <br /> by railway employes and tlre cost bome by Applicant. !(in the opinion of tY,e Railway Company sulficient hazard is involved <br /> the Applicant wil! be required to fumish liabiliry and property damage insurance in /orm and amounts satisfactory ro <br /> BuAingtan orthem. <br /> �j� � ,/ � <br /> By ,2dr //�f���q'L /,(,Ode-G«�s �.,(ntGi <br /> ° IA�'Plicanll 1 lel <br /> RECOMMENDATIONS: pf additional space is required attach supplemental sheet) <br /> Date 19 <br /> APPLICATION APPROVED: ' <br /> (Superintendont) _,_j <br /> (Aat.Vico President—Operetions) <br /> (Genoral Manoger Leases� (Regianel Menagor Eneinoaring) <br /> FOPM 1G002 1-73 <br /> Printal in U.S.A, <br />