VILLAGE OF SOUTHERN VIEW, ILLINOIS
3412 South 5th Street
Southern View, Illinois 62703
UTILITY RIGHT-OF-WAY CONSTRUCTION
APPLICATION AND PERMIT NO. ________
WHEREAS, I (We) __________________(Name of Applicant), _______________________________
_____________________(Mailing Address) ____________(City), ___________(State)___, hereinafter termed the Applicant, request permission and authority to do certain work herein described on the right-of-way of the Village streets known as ________________________________________________
___________________________________________________________________________________.
The work is described in detail on the attached sketch and/or as follows:
It is understood that the work authorized by this permit shall be completed within _____ after the date this permit is approved, otherwise the permit becomes null and void.
This permit is subject to the conditions and restrictions attached to this sheet.
This permit is hereby accepted and its provisions agreed to this _______day of _____________, _____.
Signed ______________________________
Applicant
Witness ____________________________ _________________________________
Mailing Address
___________________________________ _________________________________
Mailing Address City State
___________________________________ _________________________________
City State Telephone No. Facsimile No.
SIGN AND RETURN TO : Village of Southern View, Village Clerk, 3412 South 5th Street, Southern View, Illinois 62703
Approved this ___________ day of ______________, 20____.
This Permit is not in effect VILLAGE OF SOUTHERN VIEW, ILLINOIS
until signed by Applicant and
approved by BY: _______________________
The Village Of Southern View, Illinois Its ___________________
First: The Applicant represents all parties in interest and shall furnish material, do all work, pay all costs, and shall in a reasonable length of time restore the damaged portions of the highway to a condition similar or equal to that existing before the commencement of the described work, including any seeding or sodding necessary.
Second: The proposed work shall be located and constructed to the satisfaction of the Village Engineer or his or her duty authorized representative. No revisions or additions shall be made to the proposed work on the-right-of-way without the written permission of the Village Engineer.
Third: The Applicant shall at all times conduct the work in such a manner as to minimize hazards to vehicular and pedestrian traffic. Traffic controls and work site protection shall be in accordance with the applicable requirements of Chapter 6 (Traffic Controls for Highway Construction and Maintenance Operations) of the Illinois Manual on Uniform Traffic Control Devices for Streets and Highways and with the traffic control plan if one is required elsewhere in the permit. All signs, barricades, flaggers, etc., required for traffic control shall be furnished by the Applicant. The work may be done on any day except Sunday, New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day. Work shall be done only from 7:00 a.m. to 6:00 p.m., local time.
Fourth: The work performed by the Applicant is for the bona fide purpose expressed and not for the purpose of, nor will it result in, the parking or servicing of vehicles on the highway right-of-way. Signs located on or overhanging the right-of-way shall be prohibited.
Fifth: The Applicant, its successors or assigns, agrees to hold harmless The Village of Southern View, Illinois and its duly appointed officers, agents and employees against any action for personal injury or property damage sustained by reason of the exercise of this permit.
Sixth: The Applicant shall not trim, cut, or in any way disturb any trees or shrubbery along the highway without the approval of the Village Engineer or his or her duly authorized representative.
Seventh: The Village reserves the right to make such changes, additions, repairs and relocations within its statutory limits to the facilities constructed under this permit or their appurtenances on the right-of-way as may at any time be considered necessary to permit the relocation, reconstruction, widening, or maintaining of the highway and/or to provide proper protection to life and property on or adjacent to the Village right-of-way. However, in the event this permit is granted to construct, locate, operate, and maintain utility facilities on the Village right-of-way, the Applicant, upon written request by the Village Engineer, shall perform such alterations or change of location of the facilities, without expense to the Village, and should the Applicant fail to make satisfactory arrangements to comply with this request within a reasonable time, the Village reserves the right to make such alterations or change of location or remove the work, and the Applicant agrees to pay for the costs incurred.
Eighth: This permit is effective only insofar as the Village has jurisdiction and does not presume to release the Applicant from compliance with the provisions of any existing statutes or local regulations relating to the construction of such work.
Ninth: The construction of access driveways is subject to regulations listed in the “Policy on Permits for Access Driveways to State Highways.” If, in the future, the land use of property served by an access driveway described and constructed in accordance with this permit changes so as to require a higher driveway type as defined in that policy, the owner shall apply for a new permit and bear the costs for such revision as may be required to conform the regulations listed in the policy. Utility installations shall be subject to the “Policy on the Accommodation of Utilities on Rights-of-Way of the Illinois State Highway System.”
Tenth: The Applicant affirms that the property lines shown on the attached sheet (s) are true and correct and binds and obligates himself to perform the operation in accordance with the description and attached sketch and to abide by the policy regulations.
Eleventh: The Applicant affirms that it has complied with § 94.053 (adopted by Southern View Ordinance 2000-01-01) in it submission of this application.
VILLAGE OF SOUTHERN VIEW, ILLINOIS
3412 South 5th Street
Southern View, Illinois 62703
INDIVIDUAL UTILITY CONSTRUCTION
PERMIT BOND NO. __________________
KNOW ALL MEN BY THESE PRESENTS, that I (We)__________(Name of Applicant)__________,
_________________________(Mailing Address)___________________________________________,
______ as Principal, and______________________(Surety Company)__________________________,
a corporation organized and existing under the laws of the State of __________________ and licensed to do business in the State of Illinois, are held firmly bound unto the people of The Village of Southern View, State of Illinois in the penal sum of _________________________ Dollars ($__________) lawful money of the United States well and truly be paid unto said, people of The Village of Southern View, the State of Illinois, for payment of which we bind ourselves, our successors and assigns, jointly, severally and firmly by these presents.
WHEREAS, Utility Right-of-Way Construction Permit No. ___________________ issued by The Village of Southern View, Illinois grants to _______________________________________________ permission and authority to construct, locate, operate and maintain the work described in said Permit upon or adjacent to _______________________ in Southern View, as more fully described in said Permit which by this reference is made a part hereof as if written herein at length, in and by which Permit the said Principal has promised and agreed to perform said described operation and related activities in accordance with the terms and conditions of and described in said Permit.
NOW, THEREFORE, if the said Principal shall well and truly perform said operations in accordance with the terms and conditions of and description in said Permit to the satisfaction of said Village and shall perform no other work or construction at said location without first applying for and receiving another permit from said Village, then no claim or demand will be made against the above obligation. Otherwise, this bond or so much thereof as may be necessary shall insure to the said Village as cost and expense to change and correct during a period of five years from the date of approval of this bond by the Village, said construction to conform to the terms and conditions of and description in said Permit.
IN WITNESS WHEREOF, WE HAVE DULY EXECUTED THE FOREGOING
This _________ Day of ____________, 20____ Principal _________________________
Surety __________________________ Address __________________________
Address ________________________________ City/State _________________________
City/State _________________________ Telephone _________________________
By _____________________________________ By _______________________________
(Seal) (Seal)
Agent for Surety ___________________ Village of Southern View, Illinois
Address __________________________ By _________________________
City/State _________________________ Its _________________________
By _______________________________
(Prior Code, Ch. 94, App. A) (Res. 2000-01-01, passed 1-10-2000)