APPLICATION TO WORK IN COUNTY ROAD RIGHT-OF-WAY
PERMIT NO. _______________
Warrick County Commissioners P.O. Box 749, Boonville, IN 47601
Phone No. 812-897-6120 Fax No. 812-897-6189
1. Road Excavation/Cuts:
Gravel: $10,00 per linear foot, except farm subsurface drain.
Minimum: $200
Hard Surface: $25,00 per linear foot
Minimum: $500
2. Plowing in Cable or Pipe:
$1.00 per linear foot.
Minimum: $100
3. Directional Boring:
$1.00 per linear foot
Minimum: $100
4. Trenching/Excavating Adjacent to Roadway:
$1.00 per linear foot
Minimum: $100
5. Boring or Pushing Under Roadway:
$150 per Bore/Push
6. Pole Lines:
$1,000 per mile
Minimum: $75 per pole
7. Setting Individual Above and Below Ground Structures (other than Poles), including Pedestals, Splicer Box, Junction Box, and Transformers:
$200 per structure
8. Roadway/Lane Restrictions and Closures:
$250/day
Check or Money Order No. TOTAL PERMIT FEE =
Bond Company: Bond Amount: $ Bond #
Applicant’s Name:
Mailing Address: P.O. Box No.:
City: State: Zip Code: Phone No.:
Fax No.: Contact Person:
Project Owner’s Name (if different from applicant): Phone No.:
Project Owner’s Address (if different from applicant):
City: State: Zip Code: Phone No.:
Fax No.:
Project Location (Must be described in reference to centerlines of streets in feet)
Project Purpose:
I hereby certify that I have the authority to bind the above-named applicant and the owner of the facilities being installed under this permit to the terms, conditions and requirements of this permit. I certify that I, the applicant and all persons performing the work authorized by this permit, understand all requirements of the Ordinance adopted by the Board of Commissioners and will abide by all of the requirements and conditions. l further certify that I, the applicant and any persons performing work authorized by this permit, will not make any changes in work from the approved plan and permit without receiving written permission from the Warrick County Board of Commissioners. The applicant and I agree to pay all attorney's fees, court costs and other damages or costs incurred by Warrick County in enforcing the Ordinance or which are a result of litigation incurred by the County as a result of this permit. The applicant, the owner of the facilities being installed under this permit and I understand that, in the event Warrick County determines that any of the facilities installed under this permit need to be repaired, relocated or removed from the right-of-way, the owner or any subsequent owner of the facilities agrees to maintain, relocate or remove these facilities in a timely manner at no cost to Warrick County or its successors. The applicant and I agree that the commencement of work covered by this permit will serve as our acceptance of all terms, conditions and requirements of the approved permit.
Date:
Signature
Printed Name Title
DO NOT WRITE IN THIS SECTION-FOR DEPARTMENT USE ONLY:
County Highway Engineer: Date:
This Permit is Approved:
As submitted.
Subject to the attached conditions.
Subject to the changes noted on the plans.
COMMENTS:
COMMISSIONERS MEETING DATE OF APPROVAL:
_____________________________________________________________
Commissioner Signature
_____________________________________________________________
Commissioner Signature
_____________________________________________________________
Commissioner Signature
INSTRUCTIONS:
1. Form must be completely filled out using a typewriter or printed using black ink. Any non-applicable blanks must be marked N/A.
2. Contact Warrick County Engineer for questions concerning this application.
3. A clear, detailed plan sheet must accompany this application. The drawing must show the R/W, edge of road, all construction details, driveways, field entrances, easements and other significant features within or immediately adjacent to the R/W. The plan must show distances to the nearest intersecting roads, dimensions of all construction and have a legend for all symbols used. Failure to include all of the above will result in the denial and return of your application.
4, The permit bond amount is based on the type and amount of work being authorized by this permit. Contact the Warrick County Highway Engineer or Board of County Commissioners for a specific amount. The beneficiary on the permit bond shall be the"Board of Warrick County Commissioners, Warrick County, Indiana".
5. Permit fee shall be check or money order made payable to the "Warrick County Treasurer". Cash can not be accepted. When complete, mail or hand deliver this signed application, along with the permit fee, permit bond and detailed plan to the above address, “Attention: County Highway Engineer”.
(Am. BC Ord. 2024-10, passed 8-26-24)