CITY OF JOHNSTON CITY
APPLICATION FOR PERMIT TO DIG IN CITY STREET
I, or We __________________________, hereby make application for permission to dig in a City street at the following location.
Address _____________________________________________ Digging being done for the purpose of:
____________________________________________________________________________________
I, or We agree to comply with all rules, regulations and deposits of the City of Johnston City, if application is approved, and further understand that:
1. The applicant shall do all work, pay all costs and shall complete project in a reasonable length of time.
2. In performing this work the applicant shall not interfere with or obstruct traffic unreasonably on the street or alley.
3. That the applicant or his or her successor, shall assume all risk and liability for accidents and damages that may accrue to persons or property on account of this work.
4. A deposit of $50.00 shall be made before any excavating work commences.
5. All trenches in street or alley must be backfilled with Grade 8 Stone and the surface of the street restored to original or better condition.
6. Upon completion of Item 5, applicant shall contact the Street Superintendent for inspection of project.
7. If Street Superintendent approves project, he or she shall sign applicant’s permit.
8. On presentation of signed application to the City Clerk, deposit shall be refunded. The above provisions are hereby understood and accepted this ______ day of __________________, _____.
______________________________________
(Signature of Applicant)
The Street Superintendent of Johnston City shall sign this permit when the above project has been completed in compliance with the rules and regulations of the City of Johnston City, for the purpose of refunding the applicant’s deposit.
_______________________________________ Date ______________________
(Signature of Street Superintendent)
CITY OF JOHNSTON CITY
APPLICATION FOR CULVERT PERMIT
I, ________________________, do hereby request permission and authority to construct a culvert on the right-of-way of the City in accordance with the information provided on this application and the accompanying sketch. (Applicant must prepare a sketch showing location, length and pertinent details.)
ADDRESS: ___________________________________________
Pipe material will be: ________________________________________
Wall thickness or gauge will be: _______________________________________
Type of joint will be: _______________________________________
DATED: _____________, 20_____ SIGNED: ____________________________________
(APPLICANT)
CULVERT PERMIT
APPLICATION Approved ( ) Disapproved ( )
If disapproved, state reasons:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
DATED: ________________, 20______ SIGNED: ________________________________
(CITY OF JOHNSTON CITY)
CERTIFICATION
The undersigned has inspected the construction and installation set forth above and finds that the same (is) (is not) in accordance with the permit.
DATED: _________________, 20______ SIGNED:________________________________
(CITY OF JOHNSTON CITY)
CITY OF JOHNSTON CITY
STRUCTURE MOVING PERMIT
NAME _____________________________________________________________
ADDRESS ____________________________________________ PHONE _________________
OWNER OF STRUCTURE ____________________________________________________________
ADDRESS OF STRUCTURE ____________________ ZONE DISTRICT ________________
PROPOSED LOCATION ______________________ ZONE DISTRICT ________________
KIND OF STRUCTURE _________________________________
SIZE OF STRUCTURE ________________________
REASON FOR MOVING STRUCTURE _________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
PROPOSED USE/PURPOSE OF STRUCTURE ____________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
(NOTE: Zoning Restrictions May Apply)
ZONING OCCUPANCY APPLICATION ATTACHED: YES______ NO______
(Including Plot Plan)
PROPOSED ROUTE (STREETS) TO BE TRAVELED _____________________________________
___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________
NAME OF MOVER ____________________________________________________________________
ADDRESS OF MOVER _________________________________________________________________
CITY - PHONE _____________________________________
SUPERINTENDENT’S ESTIMATED DEPOSIT FOR REMOVAL OF UTILITIES, TREES, ETC.
$_______________________
HAS LIABILITY INSURANCE POLICY BEEN FILED? ________ AMOUNT $ _____________
HAVE FEES BEEN PAID?________ AMOUNT $___________
___________________________________ ______________________________________
ZONING OFFICIAL CITY COLLECTOR
(2010 Code, Ch. 33, Applications; Permits)