Whitespace

Right of Way Permit

For any work done within the City right-of-way (ROW) such as needing to cut into streets or access utilities in alleyway will require a work permit from the City of Brush!. Please submit the below application. Proof of liability insurance is required, and can be submitted as an attachment. Maximum three working days is required for approval, so please plan accordingly.
MAKE SURE YOU CALL 811 BEFORE DIGGING, OR GO THROUGH THEIR ONLINE PORTAL

GENERAL INFO
Owner's Name:

Owner's Address:

City:

State:

Zip:

Phone:


Contractor:

Address:

City:

State:

Zip:

Phone:

Emergency Phone:

Email:

License:


PROJECT INFO
Work Location Description:

Address:


Lot:   Block:   Subdivision: 
Nearest Intersection:

Project Start Date:

Project End Date:


Type of Work:
 Trencher |  Boring |  Open Cut
 New |  Repair
Depth:   Width:  Length: 
Purpose:
 Water |  Sewer |  Gas |  Electric |  Phone |  Other

SURFACE IMPROVEMENTS
Asphalt Roadway
Length:   Width:   SF: 

Gravel Roadway
Length:   Width:   SF: 

Concrete
Length:   Width:   SF: 

Driveway
Culver Length: 

ATTACH COPIES OF THE FOLLOWING (as applicable)
Traffic Control Plan:  Yes   No 
Landscaping Plan:  Yes   No 
Downtown Provisions:  Yes   No 
Insurance Provided:  Yes   No
Time of Day Operation: 
Engineer's Name: 
Development Plan Approval Date: 
Follow Up As-Builts Required:  Yes   No

Traffic Control Company:

Phone:


Traffic Control Company Supervisor Name:

Traffic Control Company Supervisor Phone:


Concrete or backfill and compaction methods for linear runs shall be tested by:
Engineer: 
Phone: