EASTHAM ROAD OPENING PERMIT
PERMIT NO:
_____
_
DATE:
______
20_
TO: TOWN ADMINISTRATOR OF
THE
TOWN
OF EASTHAM
Pursuant
to
the provisions
of
the Charter
of
the Town
of
Eastham and the applicable provisions
of
Massachusetts
General Laws, the undersigned respectfully requests that your written consent be given to dig up and/or tunnel
under the ground
in
the following public ways for the following purpose:
LOCATION:
(Attach plan
of
work area, sketch
on
rear may
be
sufficient)
PURPOSE:
The undersigned agrees to conform to all applicable laws and ordinances, and to abide by all stipulations attached
to the approved Permit.
In
addition, the undersigned agrees
by
the acceptance
of
this Permit to be responsible for
all acts
in
connection with this Permit and has appropriate insurance coverage for any injuries to persons or
property and indemnifies the Town
of
Eastham for any of its acts
in
connection with this Permit and to
be
responsible for trench maintenance during period
of
construction as well as trench repairs caused
by
settlement
for a period of one year from the date
of
project completion.
(Applicant) (Telephone Number)
(Applicant's Signature)
(Address)
Reviewed
by
Highway Surveyors:
_______________
Dated:
_______
_
Special Conditions:
______________________________
_
Permission recommended for the foregoing request
by:---------.,..,...-----------
(Superintendent DPW)
I,
the undersigned Town Administrator
of
the Town
of
Eastham, hereby give my written consent to the digging
up
and/or going underground
in
Town ways as above requested
and
upon the conditions set forth below this
day
of
20__
---
"The applicant(s) or their agent shall complete the work promptly, including putting the road back
in
good repair
within a reasonable time and to the specifications
of
the Department
of
Public Works". The Department of
Public Works must
be
notified at least 24 hours
in
advance of scheduled trench compaction and/or re-
paving.
NOTE: CAUTION
-CONTRACTOR
DO
NOT
DIG
UNTIL YOU
HAVE NOTIFIED ALL UTILITY COMPANIES,
WATER COMPANIES, SEWER DEPT. ANQ POLICE.
See Chapter
82,
Section 40, General Laws
Commonwealth of Massachusetts (Notification)
(Town Administrator)
