Fillable PERMIT TO PERFORM WORK IN PUBLIC RIGHT-OF-WAY (Lake Havasu City)

Fill Online, Printable, Fillable, Blank PERMIT TO PERFORM WORK IN PUBLIC RIGHT-OF-WAY (Lake Havasu City) Form

Use Fill to complete blank online LAKE HAVASU CITY (AZ) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

PERMIT TO PERFORM WORK IN PUBLIC RIGHT-OF-WAY (Lake Havasu City)

On average this form takes 10 minutes to complete

The PERMIT TO PERFORM WORK IN PUBLIC RIGHT-OF-WAY (Lake Havasu City) form is 1 page long and contains:

  • 1 signature
  • 2 check-boxes
  • 35 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Lake Havasu City

BROWSE LAKE HAVASU CITY (AZ) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
N:\CDD\FORMS - CSD REVISED FORMS\GROW Permit Application.xls Rev 6/12/12
PERMIT TO PERFORM WORK IN PUBLIC RIGHT-OF-WAY
LAKE HAVASU CITY
COMMUNITY SERVICES DEPARTMENT
2330 MCCULLOCH BOULEVARD NORTH
LAKE HAVASU CITY, AZ 86403
TELEPHONE (928) 453-4149
TELEPHONE (928) 453-6337
CONSTRUCTION/PROPERTY ADDRESS
LEGAL DESCRIPTION
TRACT ________ , BLOCK ______ , LOT ______ , OR TOWNSHIP ______N, RANGE ______W, SECTION _______
PERMITTEE (APPLICANT) PERMITTEE'S ADDRESS PHONE NO.
OWNER OF PROPERTY OWNER'S ADDRESS PHONE NO.
CONSTRUCTION CONTRACTOR CITY BUSINESS LICENSE NO. CONTRACTOR'S ADDRESS PHONE NO.
DESCRIPTION OF RIGHT-OF-WAY WORK (BE SPECIFIC) CONTRACTOR'S STATE LICENSE NO. CLASS
PROPOSED □ EXISTING □
ACCESS ONLY MONITORING WELL
GRADING PUMP STATION
LANDSCAPING/TREES SIGN
BOULDERS/ROCKS TEMP. CONSTRUCTION
CONCRETE/COLORED WORK IN WASH - NO 404
PAVERS OTHER
ELECTRICAL EQUIPMENT OTHER
NOTE: ALL WORK IS TO BE INSPECTED BY THE LAKE HAVASU CITY COMMUNITY SERVICE DIVISION
TWO (2) PLANS ARE REQUIRED FOR SUBMITTAL WITH PERMIT APPLICATION
CALL 453-4149 AT LEAST 24 HOURS IN ADVANCE FOR INSPECTION
NO INSPECTIONS WILL BE PERFORMED ON WEEKENDS OR HOLIDAYS
NO STREET CUTS ALLOWED ON STREETS RECONSTRUCTED WITHIN THE LAST FIVE (5) YEARS
I agree to the conditions set forth on the reverse side of this application, and understand that the work must be done in conformity with the
laws of the City of Lake Havasu City, and the State of Arizona.
SIGNATURE OF APPLICANT:____________________________________________
DATE:_____________________________________
FOR COMMUNITY SERVICE DIVISION USE ONLY
PLANS APPROVED BY:
DATE APPROVED:
SPECIAL CONDITIONS:
GENERAL R.O.W. PERMIT
click to sign
signature
click to edit
N:\CDD\FORMS - CSD REVISED FORMS\UTILITY-ROW-GROW General Conditions.doc Revised 6/1/2012
LAKE HAVASU CITY
Permit to Perform Work in
Rights of Way and Public Utility & Drainage Easements
GENERAL CONDITIONS
1. No work will be performed in any public right-of-way or easement without proper permits and inspection by
the Lake Havasu City Community Services Department. The permittee shall call the Lake Havasu City
Community Services Department IVR system at (928) 855-3816 by 4:30 p.m. for following business day
inspections on permitted projects.
2. All work in public rights-of-way or easements shall be performed by Contractor(s) licensed in Arizona and
possessing a current Lake Havasu City Business License to perform the work, unless otherwise exempt.
3. Permittee shall assume all responsibility and liability to the fullest extent permitted by law for any injury or
damage to any person or property lawfully using or placed within the public right-of-way and/or easement
caused by or arising out of this permitted project. PERMITTEE SHALL PROVIDE PROOF OF INSURANCE
unless current proof of adequate insurance is already on file.
4. Any property or improvements installed within a public right-of-way or easement pursuant to this permit
remains the property of the installer, who shall maintain and repair their property as required by
circumstances and/or Lake Havasu City.
5. All work shall be performed in accordance with the Lake Havasu City Community Services Department
standards and/or details, unless otherwise noted.
6. All job sites shall comply with OSHA standards and regulations.
7. All sewer and water projects shall be constructed in accordance with Arizona Department of Environmental
Quality (ADEQ) regulations and the Arizona Revised Statutes.
8. Permittee shall be responsible for the location of all underground utilities by calling 1-800-STAKEIT (782-
5348))
9. Permittee shall be responsible for the preservation of all survey monumentation (public/private). Permittee is
responsible for the replacement of damaged or removed monuments, which shall be replaced by an Arizona
Registered Land Surveyor (R.L.S.)
10. Permittee shall comply with the provisions for Traffic Control in accordance with the most recent edition of the
Manual on Uniform Traffic Control Devices (MUTCD) and provide a Traffic Control Plan with permit
application.
11. Permittee shall provide Pre-Construction photos for the project limits with permit application.
12. Permittee shall provide two (2) sets of plans with permit application.
13. Permittee shall perform/submit at minimum one compaction test for every street crossing and/or 12” lift for
250 lf of the permitted project. Results of compaction test shall be submitted to the City’s Community Services
Department prior to final inspection.
14. Permittee shall provide City written agreements between any private landowner and the permittee if storage is
to occur on private property with permit application. City parcels, ROW, and other easements not a part of the
permitted project shall require Community Services Department authorization prior to use.
15. When crossing utilities of any type, trenches must be left open until inspected and approved by the
Community Services Department Inspector. All trenches in the public right-of-way shall be backfilled at the
end of each day.
N:\CDD\FORMS - CSD REVISED FORMS\UTILITY-ROW-GROW General Conditions.doc Revised 6/1/2012
GENERAL CONDITIONS
Page Two
16. Permittee shall provide hot mix patches on all street cuts, unless otherwise approved by the Community
Services Department.
17. Any and all public rights-of-way, easements, and/or utilities damaged or disturbed during work permitted
herein shall be repaired or replaced by the permittee at their own expense prior to final inspection.
18. If the project fails final inspection, the permittee shall repair, remove, and/or replace the defective work at their
own expense within the permitted time. If at any time thereafter, any work performed by the permittee is
defective and/or of lower quality of existing materials, the permittee shall replace the defective work with the
kind and quantity of material as specified by the Community Services Department. All work shall come with a
1-year warranty.
19. In the event that a public right-of-way or easement or any portion thereof occupied or used by the permittee
pursuant to this permit may be needed by Lake Havasu City for any reason, the permittee shall, at their own
expense, remove, relocate, raise, or lower their property within a reasonable time after being notified by Lake
Havasu City.
20. The City encourages the permittee to discuss individual projects with the other Utility Companies and future
projects within the applied project corridor. A joint trench may be required if other utilities will be working
within the same corridor to reduce street cuts, costs and interruption to local traffic. (Sudden Link, Unisource
Electric, Unisource Gas, Frontier)
21. Failure to comply with these conditions may result in a work stoppage, removal of installation at permittee’s
expense, revocation of permits, and/or applicable penalties.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

PERMIT TO PERFORM WORK IN PUBLIC RIGHT-OF-WAY (Lake Havasu City)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 3 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document