APPLICATION FOR A PERMIT TO EXCAVATE
WITHIN STREET OR ALLEY RIGHTS-OF-WAY OF INGALLS, INDIANA
Fee ________ Check# ________ Receipt _________ Permit#________ Date________
Contractor Name ___________________________________________ Phone ________________
Address ________________________________________________________________
Applicant _________________________________________________ Phone _________________
Address _____________________________________________________________________________
Pager# _______________ Cell Phone# __________________ After hrs#__________________
Excavate - Location: ___________________________________________________________________
Purpose: ____________________________________________________________________________
Type of Street Surface: ___________________________ [A copy of Worker’s Comp & Liability must
be attached]
1. All applicants must request utility locates from “Holy Moly” service prior to any work.
2. The Superintendent of Streets is to be notified at the beginning of the work; and also prior to any backfilling and placement of patch materials of placement of driveways, curbs or sidewalks.
3. Upon completion of all work, the applicant shall request an inspection by the Superintendent of Streets. If all the work is satisfactory, he or she will sign the release.
4. If the work is deemed unacceptable, the town shall reserve the right to withhold the release for up to one year from date of work.
5. I/We further agree to assume all responsibility for any injury or damage to persons or property resulting directly or indirectly from the work proposed in this application.
6. I acknowledge the receipt of the rules and regulations and agree to abide by them per Ordinance 1998-5.
7. A bond may be required for proposed work at the discretion of the Town Clerk-Treasurer as circumstances dictate.
Accepted by:
________________________
Signature _______________________ Release Date
________________________
Company _______________________ Street Dept. Inspector
_____________________
Address ________________________ Position
_______________________________
(Ord. 1998-5, passed 3-23-1998)