Name of Road
Distance from nearestintersection
Is a Utility Involved?
Is This anEmergency Repair?
Will There BeExcavation Within3 Feet of or Underthe Pavement?
Description of work
If excavation is to occur, what is the nature of the work and will it require the cutting of the road or boring there under?
It must be understood that this application does not constitute permission to do work within the right of way, but is only an application for a permit. You will receive notices as to our decision to issue a permit for the job.