§ 153.19 STREET CUT APPLICATION AND PERMIT FORM.

   The application and permit form for street cuts will appear substantially as follows.

STREET CUT APPLICATION & PERMIT
Date: ___________
Permittee: ________________________	Phone No: _________________________
Signature: ________________________	Title: _____________________________
Address: __________________________________
__________________________________________
Location of proposed street cut: _________________________________________________________________
____________________________________________________________________________________________
Size of proposed street cut: _____________________________________________________________________
____________________________________________________________________________________________
Date of proposed street cut: _____________________
Completion date of proposed street cut: ___________
Permittee hereby agrees to abide by all the RESPONSIBILITIES and CONDITIONS listed in this STREET CUT PERMIT APPLICATION and Gas City ORDINANCE # 2001-12 governing STREET CUTS.
RESPONSIBILITY: Applicant shall:
1.   Install and maintain barricades, signs, lights, etc., and all traffic controls (flag people, etc.) in accordance with the latest edition of the Indiana Manual of Uniform Traffic Devices (IMUTCD).
2.   Indemnify and save harmless the City of Gas City, its agents, and employees for any and all claims for damages or actions arising out of the work performed under this permit.
3.   Keep a copy of the approved permit with each work crew while work is in progress and present it upon request by and Gas City Official.
4.   Notify all law enforcement and emergency agencies (police, fire, ambulance, etc.) in the event that any lane closings are required for the work that is to be performed under this permit.
5.   Remove and/or relocate any facilities when required by the City of Gas City for performance of construction of maintenance activities on the City of Gas City right-of-way. Removal and/or relocation of facilities in the City of Gas City right-of-way shall be at the sole expense of the permittee except as provided for by applicable statutes.
6.   Attach to this application a map showing all drainage structures and title ditches adjacent to the right-of- way where work is to be performed under this permit.
7.   Attach to this application proof of notification of all adjacent property owners by either registered or certified mail.
8.   Attach to this application drawings or sketches showing the work to be done under this permit and its application.
9.   Contact the Zoning Officer of the City of Gas City upon completion of the project.
10.   ________________________________________________________________________________________ ________________________________________________________________________________________
CONDITIONS: The following conditions apply to granting this permit:
1.   This permit is valid for 90 days from the date of approval. If the work covered by this permit is not completed within this time, a new permit will be required.
2.   This permit is valid only for work on the right-of-way for the City of Gas City. Permittee shall obtain approval from appropriate agencies for work done outside the incorporated area of the City of Gas City and secure consent by easement or other legal document from abutting property owners for work performed outside the City of Gas City rights-of-way.
3.   This permit in no way relieves the permittee from meeting all applicable federal, state, and local laws.
4.   Attach to this application a non-refundable fee of $10.
5.   ________________________________________________________________________________________ ________________________________________________________________________________________
APPROVAL: This permit application is approved subject to the requirements set out in this permit application and Gas City Ordinance #2001-12.
_____________________________________________ ZONING OFFICER               DATE	_____________________________________________ STREET COMMISSIONER            DATE

 

(Ord. 2001-12, passed 2-5-2002)