Fillable City of St. Marys, PA Street Department (City of St. Marys)

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City of St. Marys, PA Street Department (City of St. Marys)

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11 Lafayette Street
20200331StreetExcavation
Saint Marys, Pa. 15857
City of St. Marys, PA
Street Department
APPLICATION FOR ROAD/STREET EXCAVATION PERMIT
PE
RMIT # ___________________________ DATE ________________________
NAM
E/ADDRESS _______________________________________________________________________________
EXCAVATION SITE ______________________________________________________________________________
EX
CAVATION SIZE _______________________ EXCAVATION DEPTH ______________________________
DE
SCRIPTION OF WORK _________________________________________________________________________
ANTICIPATED OPENING SIZE IN:
Roadway _________ SF. (Paved / Unpaved), Shoulder ___________ SF., Outside Shoulder __________ SF.
ST
ART DATE____________________ COMPLETION DATE ____________________
EM
ERGENCY _______________ (yes/no) PA ONE CALL ID # _________________________________________
Per
mittee agrees to fulfill all terms of the City of St. Marys Resolution #07-1 regulations about road and street
excavations.
IN
TENDING TO BE LEGALLY BOUND, the applicant has caused this application to be duly executed below.
_________________________________________________ ___________________________________
Signature of Applicant City Officer
PERMIT
Permit No. _________________
The
CITY OF ST. MARYS hereby issues a permit to ____________________
_________________________________________________________for work at
___________________________________________________________________
in accordance with and subject to the conditions of the above application. This
permit shall not take effect until the applicant has paid the required filing fee.
CI
TY OF ST. MARYS
__________________________________ ___________________________
City Officer Date
No w
ork is to be performed (except in an emergency) before this application is
approved and permit is granted. A copy of this permit is to be available on site while
work is in progress.
FEES
1. Ro
adway
a) Pav
ed __________________
b) Unp
aved ________________
2. Sh
oulder _________________
3. Ou
tside Shoulder__________
TO
TAL FEES _______________
Bi
lled _____________________
Pai
d ______________________
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City of St. Marys, PA Street Department (City of St. Marys)

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Completed 16 July 2020

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