R-153 - 05/14/1974 - ISTHA - Resolutions.. �r r'fyJ'iO�ollAt:
ATTEST: 7
..Y111age Clerk
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APPLICATION FOR PERMIT
TO USE
TOLL HIGHWAY RIGHT OF WAY
THE ILLINOIS STATE TOLL HIGHWAY AUTHORITY•
(Submit Five Copies)
,
(b) TollwayMile (f) NeantstCrosaRoad Maym -13 Road.
(c) .Toliway Station
7808 + 75C + / —)
(d) Sec 28 Twp 39 N., R- 1l
(3) The Applicant attaches hereto and makes a part hereof plans and stwelfications of structure
which use Toll Highway Right of Way. Applicant agrees to'furnish such additional plans and specifica-
tions of structure as the Authority may request. In the event a permit is issued, applican) agrees to
construct such work in accord with the plans and specifications submitted to the Authority.
(4) The applicant further agrees and understands that the concession in the form of a permit
herein requested, If issued, does not sell, lease or otherwise dispose of or'encumber the Toll Highway
Right of Way; or any part thereof, and does not create any charge or lien on the revenues of the
Toil Highway.
(5) The applicant further agrees that, in the event a permit is granted, apjk6mt will, betore
commencing work under the permit, comply with all the Utility Regulations as adopted by the Autt mify it
on August 31, 1973 and the acceptance, notice, bond and hwmmce requirements of the Authority, as set .
forth In the permit.
it
(6) The Authority, in Issuing the permit herein applied far, may rely upon the steatents made
herein as true.
WITNESS the signature_. and seal of the applicant_ this I ` ray of
AM. 19-1-1
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STATE OF MOIS 1j SS . '
a Notary Public in and for and resldiag in said County
In the State aforesaid. do hereby certify
personally known to me to be the same persons whose names subscribed to the foregoing instrument
appeared before me this day in person and acknowledged that.2,07he,01 signed, sealed and delie.erod the
same instrument free and voluntary act for the use and purposes set forth herein.
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Given under my head and notarial seal thisl��agy o A.D. ,9z4
NOTE FOR SIGNATURES
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