Greene
County
Building and Zoning Department
PUBLIC
RIGHT
OF
WAY
UTILITIES
PERMIT
APPLICATION
OFFICE
USE
ONLY:
Permit
Number:
_______________
Permit
Fee:
__________________Date
Approved:
___________________
CAREFULLY
READ
AND
INITIAL
ACKNOWLEDGING
YOUR
UNDERSTANDING
OF THE
FOLLOWING
STATEMENTS:
_______
Initial.
A
schematic
drawing
of
the
construction
plans
of
the
utility
facility
and
a
plat
or
map
showing
the
location
of
the
utility
facility
in
relationship
to
the
existing
roadway,
pavement
or
curb
must
be
submitted;
this
includes
public
and
private
utilities.
_______
Initial.
Private
utility
permits
may
be
required
to
post
a
construction
and
maintenance
bond.
_______
Initial.
Private
permits
shall
expire
unless
completed
within
ninety
(90)
days
of
issuance.
_______
Initial.
All
contractors and
individuals
are
required
to
have
all
other
utilities
identified
and
marked
before
any
digging,
or
excavating
begins.
_______
Initial.
Contractors
must
present
with
this
application
a
copy
of
their
State
of
Georgia
Utility
Contractor's
License,
Proof
of
Identification
and
a
current
Certified
Level
I
Blue
Card
issued
by
the
Georgia
Soil
and
Water
Conservation
Commission
with
legible
Certification
Number,
Date
Issued
and
Expiration
Date.
Name
of
Road
and
General
Location:__________________________________________________________
Total
Feet
of
Utilities
to
be
Installed:
_________________
(2,640
ft
=
1/2
mile)
Date
to
Begin
Work:
____________________
Approximate
Duration: ______________________
Fees
are
as
follows:
$50
for
first
half
(1/2)
mile,
$25
for
each
half
(1/2)
mile
thereafter.
Applicant
Name
(Print)
Applicant
Signature
Page 1 of 1
Date
Chuck Wooley
Building Official
Approved
By:
_____________________________________________________________________________
Applicant
Name:
__________________________________________
Phone:
_________________________
Address:
____________________________
City/State:
____________________________
Zip:
__________
Email:
__________________________________________________________________________________
N
Contractor ame: __________________________________________ Phone: _________________________
Address: ____________________________ City/State: ____________________________ Zip: __________
Email: __________________________________________________________________________________
________________________________________________________________________________________
____________________________________________________________
____________________________________________________________
________________________
1034 Silver Dr., Ste 103, Greensboro, GA 30642 -
Telephone (706) 453-3333 - FAX (706) 453-2579
www.greenecountyga.gov/building
