Utility Permit

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4. PRICE COUNTY HIGHWAY DEPARTMENT - APPLICATION/PERMIT TO CONSTRUCT, MAINTAIN, AND OPERATE UTILITIES WITHIN HIGHWAY RIGHT-OF-WAY

6. Company Name*

8. Address*

10. City*

11. State

12. Zip*

14. Office Phone Number*

15. Cell Number

19. Type of Utility Installation*

21. Installation Start Date*

22. Installation Finish Date*

24. County Highway*

25. Town, City or Village of*

29. Legal Description of Property Served

31. Quadrant*

    Example: SE 1/4 of NE 1/4

32. Section*

33. Township*

34. Range*

38. Plans Prepared By*

39. Email*

41. Name of Utility Person Responsible for Construction*

43. Phone Number of Utility Person Responsible for Construction*

45. Check ALL that apply*

    1. Highway Crossing
    2. Underground
    3. Bridge Attachment

    1. Overhead
    2. Directional Bore
    3. Temporary Installation

46. Construction*

    1. Major
    2. Minor

48. The Applicant understands and agrees that the permitted work shall comply with all permit provisions and conditions of the Price County Utility Policy in effect at the time of this application, and with any special provisions attached or made part of this permit.

50. Signature of Authorized Representative*

51. Date*

53. Title*

54. Phone Number for Authorized Representative*

58. Each permit application shall contain adequate drawings showing the proposed location of the utility facility within the right-of-way with respect to the existing highway or any proposed highway improvement and any exisitng utility facility. Please attach drawings below.

60. Permit Drawing

61. Permit Drawing

62. Permit Drawing

Leave This Blank:


63. 1. Receive email copy
64. Email address

    This field is not part of the form submission.

65. Submit

* indicates a required field