Fillable Driveway-right-of-way-permit-application Vacation of Right-of-Way Application Draft

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Driveway-right-of-way-permit-application Vacation of Right-of-Way Application Draft

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U.S.A. forms for City of Semmes

BROWSE CITY OF SEMMES (AL) FORMS

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Semmes, A Place We Call Home • Incorporated 2011
Phone: 251/649-5752
Fax: 251/649-5788
www.cityofsemmes.org
3940 Illinois Street
P.O. Box 1757
Semmes, AL 36575
FOR CITY OF SEMMES USE ONLY
Permit No.
Fee Paid: $
Date Paid:
Receipt for Pipe Received:
Pipe Received:
☐Cash
☐Check
Check No.
Person/Organization:
Email:
Phone:
Address of Project:
Mailing Address:
24-hour Emergency Contact: 24-hour Phone No: ( )
Reason for Permit:
I hereby state all information is correct. I also agree to be bound by the provisions of the City of Semmes ordinances (2015-02; 2017-04), specifications and regulations, in addition to any restrictions and
regulations as may be imposed by the Public Works Superintendent or his/her designee. The undersigned does hereby certify that he/she is the duly authorized Agent of the Applicant for the purpose of binding
the Applicant to the terms and conditions of this application and this information.
Permittee Signature: ______________________________________ Date: _______________________________
FOR CITY OF SEMMES OFFICE USE ONLY
PW Comments:
Site Visited:
By:
Size
Length
Type
Ordered From:
Receipt on File: ☐Yes ☐No
Will work be done in non-paved area? ☐ Yes ☐ No
Will a street or lane closure be required? ☐ Yes ☐ No
Will a sidewalk closure be required? ☐ Yes ☐ No
FOR CITY OF SEMMES OFFICE USE ONLY
Final Acceptance: PUBLIC WORKS DEPARTMENT ☐ ACCEPTED ☐ REJECTED
Accepted By: ________________________________________________________ Date: _____________________
Page 2 of 2
FOR PROJECTS NEEDING A SKETCH, PLEASE DO SO ON THE
WORKSHEET BELOW
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Driveway-right-of-way-permit-application Vacation of Right-of-Way Application Draft

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Completed 12 July 2020

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