Greene
County
Building
Inspection
Division
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
Renee' Criswell
Office Manager
Jamie Brantley
Permit Clerk
Brad Cherry
Building Inspector
Scott Allen
Code Enforcement
1034 Silver Dr., Ste 103, Greensboro, GA 30642 Telephone 706-453-3333 www.greenecountyga.gov
Approved
By:
_____________________________________________________________________________
Applicant
Name:
__________________________________________
Phone:
_________________________
Address:
____________________________
City/State:
____________________________
Zip:
__________
Email:
__________________________________________________________________________________
N
Contractor ame: __________________________________________ Phone: _________________________
Address: ____________________________ City/State: ____________________________ Zip: __________
Email: __________________________________________________________________________________
________________________________________________________________________________________
____________________________________________________________
____________________________________________________________
________________________
