COUNTY RIGHT OF WAY UTILITY PERMIT APPLICATION

Project Information:

Project Name: [PROJECT NAME] Location: [ADDRESS OR LEGAL DESCRIPTION]

Permittee: [NAME OF PERMITTEE]

Work Being Done For: [ENTER NAME OF COMPANY WORK IS BEING DONE FOR]

Address of Permittee: [ADDRESS OF PERMITTEE] City: [CITY] State: [ST] Zip: [ZIP CODE]

Contact Person: [CONTACT NAME AND PHONE NUMBER] Utility Type: [TYPE OF UTILITY]

Specifications:

Please review and adhere to the following specifications:

The utility shall be installed at a minimum depth of 36 inches, as required by applicable codes and regulations.

The utility shall be installed using approved materials and methods in accordance with industry standards and applicable codes and regulations.

The utility shall be marked at the surface at intervals of [ENTER INTERVALS] with durable, visible markers that identify the utility type and owner.

The utility shall be tested and inspected in accordance with applicable codes and regulations to ensure that it is free of leaks and defects before it is covered.

Surface-mounted objects, such as pedestals and transformers, shall be placed on the back side of the county right-of-way or ditch, as to not interfere with regular county ditch maintenance. The surface markers shall also be placed on the back side of the county right-of-way or ditch.

The permittee shall provide a detailed map showing the location of the utility and any other underground utilities in the vicinity of the permitted work.

The permittee shall obtain all necessary permits and approvals from applicable regulatory agencies and utility providers prior to commencing the permitted work.

The permittee shall comply with all applicable laws and regulations regarding excavation, trenching, and backfilling.

The permittee shall take all necessary precautions to ensure the safety of the public and property during the permitted work, including but not limited to, barricading and marking the work area and providing adequate lighting and signage.

The County shall not be responsible for any costs associated with relocating or repairing the utility if it needs to be moved or damaged due to a bridge or culvert replacement project, road construction or maintenance, or any other county project that requires work in the vicinity of the permitted project.

Signatures and Approval:

By signing below, the permittee agrees to comply with all conditions and specifications of this permit and assumes all responsibility and liability for any damages, costs, or injuries that may result from the permitted work.

Project Name: [PROJECT NAME] Location: [ADDRESS OR LEGAL DESCRIPTION]

Permittee Signature: __________________________________________________ Date: ___________________

Approved By:

Clay County Commissioners Representative: _______________________________ Date: ___________________

*Please attach a detailed map and any additional information that may be helpful for the review of this permit.