Right of Way Construction Permit
Date: __________________ Permit Number: ________
This permit is issued to: _________________________________________________________
for the purpose of constructing a: __________________________________________________
in the public right of way in Keith County, Nebraska in the following location: ______________
______________________________________________________________________________
______________________________________________________________________________
$25.00 Permit Fee
The required vertical headroom under the County road ditch shall be 3’ (three feet) minimum and below the flow
line of any existing culvert. All trench installations shall be mechanically tamped to the full width of the right of
way to preclude the possibility of settlement in the roadway and ditches, and shall be compacted to 95% of
compaction. The utility owner will be responsible for any additional gravel that is required and for seeding any
disturbed areas with a reliable game commission mix. The utility owner will be responsible for any damages created
from erosion due to channelization of water from the utility installation. The utility owner will be responsible for
moving said utility if County road construction requires and at NO cost to Keith County.
The construction of all utilities will conform to the standards set forth in the “Nebraska Department of Roads-Policy
for accommodating utilities on State Highway right-of-way.” Adopted by Keith County as the “Keith County Policy
for accommodating utilities on public road right-of-way.” The permit holder shall inform the Keith County Highway
Department upon completion of construction of the above-described utility in order that all road crossings and
backfill areas may be inspected. The permit holder agrees it will restore the public roads and related structures
where it, or any of its contractors, will be working to the same condition as they were prior to it’s work, and will
accomplish such restoration to the reasonable satisfaction of the Keith County officials. The permit holder shall also
exempt Keith County from any damage that may result to the above-described utility as a result of future road
maintenance or construction. All utilities, electric, water, gas, etc. shall be cased, unless otherwise specified. The
holder of this permit SHALL be responsible for work zone safety, and the proper signage in accordance with the
MUTCD manual.
Any accesses adjoining paved roads will require a lug to be installed at applicant’s expense.
_____________________________________ _________________________________
Name of Applicant Keith County Highway Department
______________________________________
Applicant Address
Final Inspection by:
______________________________________ __________________________________
Applicant Phone Number
_______________________________________
Applicant Signature
