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Street Forms

VILLAGE OF WESTVILLE

 

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)

 

VILLAGE OF WESTVILLE

 

APPLICATION FOR CULVERT/DRIVEWAY PERMIT

 

 

          I, ____________________________, do hereby request permission and authority to construct a culvert/driveway on the right-of-way of the Village 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: _________________________, ____  SIGNED:                                              

                                                                                          (APPLICANT)

 

CULVERT/DRIVEWAY PERMIT

 

APPLICATION                 Approved (  )                  Disapproved (  )

 

If disapproved, state reasons:

 

                                                                                                                                 

 

                                                                                                                                 

 

                                                                                                                                 

 

DATED: _________________________, ____  SIGNED:                                              

 

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: _________________________, ____  SIGNED: