PERMIT #
STATE OF:
COUNTY OF:
Subscribed and sworn to before me, a notary public in and for said county and state, this day of , 20.
Notary Public
My commission expires
BOND REQUIREMENTS FOR PROTECTION OF STREET FACILITIES:
$5,000.00 SURETY POSTED BY CONTRACTOR DOING UTILITY WORK
$500.00 SURETY POSTED BY ADJACENT OWNER (HOMEOWNER)
PUBLIC UTILITY INDEMNIFICATION AGREEMENT POSTED
OFFICE USE ONLY
INSPECTION FEES
INSPECTION FEE FOR MAILBOX AND DRIVEWAY -- $20.00
INSPECTION FEE FOR DRIVEWAY ONLY -- $20.00
INSPECTION FEE FOR MAILBOX ONLY -- $20.00
INSPECTION FEE FOR SPECIAL EVENTS -- $20.00
REVIEW PLANS -- $20.00
INSPECTION FEE $20.00 TIMES NUMBER OF DAYS NEEDED = $
.
STREET SPECIFICATIONS
CLASS I
CLASS II
CLASS III
CLASS III SUBDIVISION
OFFICE PERSONEL WITNESS: