Fillable Application For Permit To Dig (City of Aliquippa)

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Application For Permit To Dig (City of Aliquippa)

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APPLICATION FOR PERMIT
TO
OPEN, DIG
OR
EXCAVATE
IN
ANY
STREET
OR SIDEWALK WITHIN THE CITY OF ALIQUIPPA
PURSUANT TO ORDINANCE NO.
4
OF
1994
1.
NAME OF APPLICANT:
2.
ADDRESS OF APPLICANT:
3.
PHONE NO. OF APPLICANT:
(
)
4.
EXACT LOCATION OF PROPOSED OPENING OR EXCAVATION:
5.
APPROXIMATE SIZE OR DEPTH OF OPENING OR EXCAVATION:
6.
DATE WORK TO COMMENCE:
7.
DATE WORK TO BE COMPLETED:
8.
REASON FOR PROPOSED OPENING OR EXCAVATION:
FURTHERMORE, I/We, the Applicant, do hereby AGREE that all work relating to the
opening, digging or excavation of any street or sidewalk within the City of Aliquippa
shall be done in full compliance with the ordinances of the City and the laws of the
Commonwealth
of
Pennsylvania in relation thereto, and that I/We the applicant shall
well and truly save, defend and keep harmless the City from and indemnify it against
any and all actions, suits, demands, payments, costs and charges for or by reason of the
proposed opening, digging or excavation, and all damages to persons or property
resulting in any manner therefrom, or occurring in the prosecution of the work
connected therewith, or from any other matter, cause or thing relating thereto.
NOTICE:
THIS AGREEMENT MAY RESULT IN LEGAL LIABILITY TO
YOU. DO NOT SIGN THIS AGREEMENT WITHOUT READING IT
CAREFULLY.
DATE:
WITNESSED:
APPLICANT
WITNESSED:
APPLICANT
***PA ONE CALL REQUIRED PRIOR TO DIGGING***
THIS APPLICATION APPROVED BY THE CITY ADMINISTRATOR THIS
DAY OF
20
City
Administrator
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Application For Permit To Dig (City of Aliquippa)

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Completed 15 July 2020

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