Job Location
Street Address/City Zip _________________________________________________________________________________________
Lot No. _________________ Subdivision __________________________________________________________________________
Permittee Information
Name _______________________________________________________________________________________________________
Phone No. ___________________________ Email ___________________________________________________________________
Acknowledgement
I, the undersigned, hereby certify that I own the above-referenced property or act as an authorized agent for the contractor/owner
and have the authority to make this application; that the information is complete and correct; and that the construction and/or use
will conform to City of Newark code and other applicable laws and regulations which relate to the property.
Applicant’s Name (Please Print) ____________________________________________________________________
Applicant’s Signature ______________________________________________ Date ________________________
Type of Obstruction
Crane Dumpster Utility Installation Vehicle Other_______________________________
Estimated Start Date _________________________ Duration ___________________________
Reason for Obstruction __________________________________________________________________________
Charge for Permit $55.00
A copy of this permit shall be affixed to the dumpster for the duration of the obstruction.
The above Applicant shall make an effort to minimize the duration of the obstruction and shall not exceed the obstruction duration
indicated on this permit. Unless permit duration is extended by the Department.
Reflective barrels shall be placed at the outside corner of the dumpster/truck in the travel lane of vehicles or reflective traffic safety
cones placed at all four corners.
Obstructions shall be located such that they do not obstruct any fire hydrants, mailboxes or neighboring driveways.
Every precaution must be taken to protect the general public while this work is in progress. The right to work under this permit expires
two weeks from date of permit issuance unless the permit is renewed or extended by the Department.
(Office Use Only)
Mark One: Approved _________ Denied ________
Authorized Signature _______________________________ Date _______________________
Permit No. ___________________
Right-of-Way Obstruction Permit Application
Right-of-Way Obstruction Permit Application [May 2020].pdf
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