City of Lynchburg Public Right-of-Way
Application for Permit to Use
Under City Code sections 25-212 and 35-12 work in City Right-of-Way requires a permit
from the Engineering Department and payment of a fee set by the City Manager. Violation
of this Code section is a Class IV misdemeanor. (Please attach work schedule and MOT plan
to this application if available).
Today's Date
Your Name
Business/Company Name (if applicable)
Business Phone Alt./Mobile Phone
Email Address
Mailing Address City
State & Zip
Worksite Location Street Address
Description of proposed use of Right-of-Way
Does this use include excavation? Yes No
Name of Project Manager if different than above
Sign Here: