Revised April 2016
Road Cut or Closure Permit
Street Department
310 Navajo Trail Burns Harbor, IN 46304
P 219-787-9187 F 219-787-0015
@burnsharbor-in.gov www.burnsharbor-in.gov
TO BE FILED A MINIMUM OF FORTY-EIGHT (48) HOURS BEFORE WORK IS TO COMMENCE
Contractor License Number
I hereby make application for a permit to close or cut a __ street, __ alley, or __ public grounds at the following
location:
The excavation will be _____ feet long in right-of-way and _____ feet long in road surface by _____ feet wide.
Approximate date of commencement of work
Approximate working days required to complete work
Reason for cut or closure:
Note: A detailed drawing or map showing an alternate route for traffic must be submitted at the time of application.
The alternate route must be such that emergency vehicles may pass through. A valid Contractor's License must
also be in place before this permit may be released.
I understand that an application fee of $200 .00 is to be submitted to the Street & Building Clerk to cover the cost
of inspection and processing of application for a street or alley cut. The application fee for a sidewalk cut shall
be $50.00. A fee of $50.00 shall be charged for a road closure in which no cut is made.
I further understand that it is my responsibility to contact Indiana Underground Plant Protection Systems, Inc. at
1-800-382-5544 at least forty-eight (48) hours in advance (excluding weekends & holidays), but no more than
twenty (20) calendar days before digging or drilling. I also agree that I will not dig or drill until the site has been
inspected and the underground utilities have been properly marked.
I agree to erect and maintain all necessary barricades, detour signs, and warning lights required to safely direct
traffic over or around the part of the road where the above described work is to be done.
