TOWN OF WE
LLINGTON
PO Box 127
Wellington, CO 80549
(970) 568-0447
RIGHT OF WAY PERMIT
DATE:
CONTRACTOR NAME: ___________________________________PHONE:
PERMIT #: 20-ROW-
________________________
EMAIL: ___________________________________FAX: ___________________________ ________
MAIL
ING ADDRESS: ____
CITY: ST. ZIP CODE:
PROP
ERTY OWNER: ___________________PHONE: ________________________
ADDRESS: ____CITY: ST. ZIP CODE:
LOCA
TION OF PROJECT_____________________
__________
PURPOSE OF EXCAVATION OR OBSTRUCTION
PLANNED START DATE PLANNED FINISH DATE
THE TOWN MUST BE NOTIFIED OF EXACT START DATE AT LEAST 24 HOURS BEFORE THE PROJECT IS TO BEGIN.
PROVIDE A DRAWING OF WORK TO BE PERFORMED AND A TRAFFIC CONTROL PLAN.
LIST ANY SPECIAL CONDITIONS
CLEA
N UP AND/OR REPAIRS TO THE SITE MUST BE REPAIRED WITHIN 14 DAYS AFTER UNDERGROUND WORK IS COMPLETE. WHEN
REPAIRS CANNOT BE MADE DUE TO INCLEMENT WEATHER, THE SITE MUST BE MAINTAINED UNTIL SUCH REPAIRS CAN BE MADE.
APPLICATION FEE $50.00
DEPOSIT $1,000.00 >REFUNDABLE UPON FINAL INSPECTION AND APPROVAL BY THE TOWN.
TOTAL $1,050.00
I HEREBY AGREE TO THE CONDITIONS CONTAINED IN THIS PERMIT
SIGNATURE DATE
PROOF OF LIABILITY INSURANCE IS REQUIRED FROM ALL CONTRACTORS REQUESTING PERMITS
**Wellington Construction Standards available upon request**
OFFICE USE ONLY
PERMIT APPROVED BY: RECEIVED BY:_________________________________
WORK COMPLETION APPROVED BY: CHECK #: _____________________________________
DEPOSIT REFUND ISSUED ON:_________________
click to sign
signature
click to edit
![]()
