VILLAGE OF NORTH BALTIMORE PERMIT TO EXCAVATE ON VILLAGE RIGHT-OF-WAYS PROPERTY OWNER PHONE # ADDRESS EXCAVATION LOCATION TYPE OF EXCAVATION PAVEMENT CUT SIDEWALK R/W (YARD) REASON FOR THE EXCAVATION CONTRACTOR DOING WORK ADDRESS PHONE # The Contractor/Applicant hereby agrees and covenants to restore public right-of-way excavated to at least the previous condition or better, within the acceptable standards and guidelines as prescribed by the Ohio Department of Transportation. The Contractor/Applicant future agrees and covenants to indemnify and hold the VILLAGE of NORTH BALTIMORE harmless for any damages which result from improper excavation, installation, or repair of such excavations performed as a condition for the repair. DATE SIGNATURE: OWNER/CONTRACTOR: OFFICE USE ONLY- SUPERINTENDENT’S ESTIMATE OF REPLACEMENT/REPAIR $ SURETY POSTED: COMPANY NAME: Cash Surety Posted: $ Liability Ins. Co.: Annual Surety Posted: Village Clerk: SUPERINTENDENTS APPROVAL: SIGNATURE: Cash Surety Returned: Date Village Clerk |
(Ord. 98-17. Passed 3-17-98.)