RIGHT OF WAY PERMIT

APPLICANT INFORMATION

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PROJECT INFORMATION

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  • Project Description (Check all that apply.)

  • Type of Work
  • Type of Utility
  • Disturbed Area(s)
  • Type of Surface(s)
  • Type of Installation
  • Excavation Dimensions or Disturbed Area

  • Date Selection
  • Date Selection
  • Traffic Impacts

  • Will work obstruct City street(s) and/or require detour of traffic?

MAPS, PLANS & DOCUMENTATION

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  • Drop files here
  • Drop files here
  • Drop files here

AGREEMENT

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  • The work done under this permit shall be in strict conformity with the ordinances of the City of Scandia, and to the standards adopted by the State of Minnesota.  The applicant shall hold harmless and defend the City of Scandia for any claim of loss or damage made against the City, its employees, or representatives arising out of the activities of the applicant.

    By signing this agreement, the applicant agrees to pay all application fees, provide any required insurance, and abide by all other terms and conditions contained herein. 

    It is expressly understood that this permit is conditional upon replacement or restoration of all rights of ways, road surfaces or other disturbed public or private property to the original or better condition prior to work described above.

  • Date will be captured on form submission

FOR OFFICE USE ONLY

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