Application for Boone County Right of Way Work Permits
Permit for Excavation in Boone County Public Right of Way
INDIVIDUAL PERMIT Boone County Resource Management
801 E. Walnut, Room 315
SPECIAL PERMIT Columbia, MO 65201
573-886-4339 / 573-886-4340 Fax
Name of Applicant: ____________________________________________ Date ___________
Address: ____________________________________________
____________________________________________
Telephone: ____________________ Fax: __________________ E-MAIL ADDRESS:
Signature of Applicant ____________________________________________
Requests permission to perform the following described work / activities with Boone County Right of Way:
Open Cut Roadway Bore Roadway Excavation Trench Other
Describe: ____________________________________________________________________________________-
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Address of Work: ______________________ Sketch Area:
Subdivision Name: ______________________
Type of Road: Curb & Gutter
Asphalt
Concrete
Chip & Seal
Gravel
A $150.00 Deposit is required for all Individual Permits before Application will be processed.
In the event injury or damage to persons or private property should occur as a result of the above work by permittee, its agents,
employees, or contractors, and as a condition to issuance of this permit, the applicant agrees to and shall be responsible for all such
injury or damage as opposed to Boone County, and agrees to save and hold Boone County, its officers, employees, agents, and
contractors, harmless from any loss of any character whatsoever that may arise from any of the work performed under this permit,
or anything done in or associated within the working vicinity of the construction area. The permittee agrees that work performed
under authority of this permit is shall comply with all regulations and policies adopted by Boone County concerning use of and
work within county maintained road right of ways. The permittee further agrees that driveways and/or property entrances disturbed
as a result of the above work authorized under this permit shall be restored to a usable condition by the end of each work day prior
to final completion of the work and disturbed areas shall be restored to a condition similar to or better than that in existence prior to
the beginning of the work. All Traffic Control must meet MUTCD.
Approved, Permit # Issued ____________ This Permit will expire: _________________
Conditions of Permit: Above construction shall be performed in accordance with Boone County Roadway
Regulations, Chapter II, Road, Bridge & Right of Way Regulations, effective date, May 13, 2004.
Contact _________________________ to coordinate activity.
Special Conditions:
_________________________________________________________________________________
_________________________________________________________________________________
Denied -
__________________________________________________________________________________
______________________________ __________
Authorized Representative Date
