Permit*:

• Repair Constrution

• New Subdivision

Company:

Address:

City:

Responsible Person:.

Dates of Work:

Location:

Description of Work:

Comments:

Exceptions or Variances:

Barrow County Utility Permit Request

• New Construction

• Old Subdivision

Utility Type: .

• Ditch (Dirt Road) • Ditch (Paved Road)

Phone:

Phone:

Plans: D Yes • No

Ihereby make application for permit as above, and if same k granted, Iagree to conform to all applicable Barrow County Ordinances andResolutions Subdivision Regulations and plans and/or specifications submitted. I further agree to construct ut.lrt.es along and inside thelegally owned and occupied right-of-way of Barrow County. Any person, firm or corporation violating any of the applicable codes, ordinances,resolutions or regulations shall be deemed guilty of a separate offense for each and every day or portion thereof during which any violation iscommitted continued, or permitted, and upon conviction of any such violation such person shall be punishable by afine, or by vnprisonrnenl.o?* both This permit ITvalid for aperiod of six months and shall expire by limitation and become null and void if the bu.W.ng or workauthorized by this permit is not commenced within six months from the issue date, or if the work authorized by such permit is suspended orabandoned after the work has commenced. 2extensions of 90 (ninety) days each maybe requested in writing, and if justified maybe grantedbv the Planning Department. I hereby warrant the truthfulness of every statement on this application and I understand thatmisrepresentations, omissions, variations, and/or discrepancies are basis for nullification. Iaccept as responsibility for this request, anynecessary restoration of private properties affected by our activities, to include, but not be limited to. ditch restoration, fill and compaction, andreseeding of affected areas, for the purpose of erosion and sediment control. All private driveways, upon crossing will be restored to originalcondition In addition to all County, State and Federal laws and regulations, Barrow County further imposes, upon the Permittee, within thedesignated corridor and the responsibility of damages to existing utilities and shall hold the county harmless for any cost or impositionresultino from said damage. Also, on right-of-way maintained by the County under the color of prescription, the County grants permission onlyto the extent of the county's vested interest. No condition inherent in this permit relieves the perrhitee of any cost or requirement to relocatewhen directed by the County. Twenty-four (24) hours NOTICE must be given, prior to construction, as an additional requirement for grantingof this request.

Signature of Applicant:

Date:

Contract forces to be used (if any):.

Business License Number:

Title of Applicant:

Issuing Authority:

DEPARTMENT DATE IN DATE OUT NAME # OF ATTACHEMNTS

GENERAL PROVISIONS

it is expressly stipulated that this permit is a license for permissive use only and the placing ofutility facilities upon public property pursuant to this permit shall not operate to create or vestany property right in the holder.

Whenever necessary for the construction, repair, improvement, maintenance, safe and effectiveoperation, alteration or relocation of all or any portion of the road as determined by theCounty, any or all of said facilities and appurtenances authorized hereunder shall be immediatelyremoved from the right-of-way, or reset or relocated thereon, as required by the chief engineer,and at the sole expense of the utility unless reimbursement is authorized by separate agreement.Should the utility fail to remove or relocate its facilities, upon due notice from the County, theutility shall be liable for any extraordinary costs or damages incurred by the county as a resultTHEREOF.

If the County undertakes to improve this road, it shall be the responsibility of the utility to planwith the county and its contractor a schedule which will clearly set forth at which stage ofoperations the utility will be required to perform any adjustment to its facilities necessary toaccommodate the road improvements.

during the initial installation or construction of facilities authorized by this permit, or duringany future repair, removal or relocation thereof or any miscellaneous operations, the utilityshall, at all times, maintain flagmen, signs, lights, flares, barricades, and other safety devices inACCORDANCE WITH THE MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES, CURRENT EDITION, AND AS MAY BENECESSARY TO PROPERLY PROTECT TRAFFIC UPON THE ROAD AND TO WARN AND SAFEGUARD THE PUBLICAGAINST INJURY OR DAMAGE.

IT IS THE UTILITY'S RESPONSIBILITY TO VERIFY THE LIMITS OF RIGHT-OF-WAY FOR LOCATION OF THE UTILITYFACILITIES AUTHORIZED HEREBY.

NO INHERENT OR RETAINED RIGHT OR PRIVILEGE OF ANY ABUTTING PROPERTY OWNER IS AFFECTED BY THISPERMIT NOR IS THE COUNTY RESPONSIBLE FOR ANY CLAIM WHICH MAY DEVELOP BETWEEN THE UTILITY AND ANYPROPERTY OWNER CONCERNING USE OF THE RIGHT OF WAY. THE UTILITY IS RESPONSIBLE FOR MAINTAININGreasonable access to private driveways during installation of its facilities and for restoration ofdriveways to the property owner's satisfaction.

The utility shall give the County a minimum of twenty-four (24) hours notice prior to beginning anywork under this permit.

This permit shall be void unless work hereunder is begun within six (6) months of the date of itsapproval.

SPECIAL PROVISION UTILITY RESTORATION AND CLEANUPPERMIT NUMBER

THE UTILITY COMPANY OR ITS CONTRACTOR SHALL PLAN, COORDINATE AND PROSECUTE THE WORK SUCH THATDISRUPTION TO PERSONAL PROPERTY AND BUSINESS IS HELD TO APRACTICAL MINIMUM.

ALL CONSTRUCTION AREAS ABUTTING LAWNS AND YARDS OF RESIDENTIAL OR COMMERCIAL PROPERTY SHALL BERESTORED PROMPTLY. BACKFILLING OF UNDERGROUND FACILITIES, DITCHES AND DISTURBED AREAS SHALL BEACCOMPLISHED ON ADAILY BASIS AS WORK IS COMPLETED. FINISHING, DRESSING AND GRASSING SHALL BEACCOMPLISHED IMMEDIATELY THEREAFTER AS ACONTINUOUS OPERATION WITHIN EACH AREA BEINGCONSTRUCTED WITH EMPHASIS PLACED ON COMPLETING EACH INDIVIDUAL YARD OR BUSINESS FRONTAGE. GARESHALL BE TAKEN TO PROVIDE POSITIVE DRAINAGE TO AVOID PONDING OR CONCENTRATION OF RUNOFF.

HANDWORK, INCLUDING RAKING AND SMOOTHING, SHALL BE REQUIRED TO ENSURE THAT ROOTS STICKS, ROCKSAND OTHER DEBRIS ARE REMOVED IN ORDER TO PROVIDE ANEAT AND PLEASING APPEARANCE. GRASSING SHALLIMMEDIATELY FOLLOW IN ORDER TO ESTABLISH PERMANENT COVER AT THE EARLIEST DATE.

IT IS THE UTILITY COMPANY'S RESPONSIBILITY TO RESTORE (AS WAS) ANY EROSION AND SEDIMENT BARRIERS THATMIGHT HAVE BEEN REMOVED OR THAT MIGHT HAVE BEEN DESTROYED DUE TO INSTALLING UTILITY WITHIN THERIGHT OF WAY OF STREETS.

THE DEPARTMENT'S ENGINEER SHALL BE AUTHORIZED TO STOP ALL WORK BY THE UTILITY OR ITS CONTRACTORWHEN RESTORATION AND CLEANUP ARE UNSATISFACTORY AND TO REQUIRE APPROPRIATE REMEDIAL MEASURES.

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