VILLAGE OF ROCHESTER
EXCAVATION PERMIT
NAME _____________________________________________________
FIRM NAME ________________________________________________
ADDRESS _________________________________________________
CITY/VILLAGE ______________________ STATE _____ PHONE _________
LOCATION OF PROPOSED EXCAVATION ___________________________________________
____________________________________________
______________________________________________
NATURE OF EXCAVATION_________________________________________________________
____________________________________________________________________
____________________________________________________________________
BONDING COMPANY:
NAME ___________________________________________________________
ADDRESS ____________________________________________________________
CITY/VILLAGE ______________________ STATE ____ PHONE _________
AMOUNT OF BOND $ _____________________________________________________________
PREVIOUS EXPERIENCE (LIST CITIES AND/OR VILLAGES)
CITY/VILLAGE CITY/VILLAGE OFFICIAL
1. ______________ ________________________
2. ______________ ________________________
3. ______________ ________________________
4. ______________ ________________________
I have read the municipal law with regard to excavations and my firm or company intends to fully comply with the street regulations code provisions.
_______________________________
(Applicant’s Signature)
(2009 Code, Ch. 34)