SMALL CELL RIGHT OF WAY UTILIZATION APPLICATION
Permit Name :
Legal Description of
Address (nearest cross
Closest Utility or
Nearest Reside. Property
Ht. of existing poles
PROJECT DESCRIPTION (Attach Plans)
Number of nodes: _____________________
Est. Cost of Work
Permit Fee Status
Approved by :______________________________________ Date:____________________________
The following permit is valid for 180 days (6 months) from the printed date.
Traffic plans are approved separately. The contractor that will be physically responsible for the traffic control on site must contact
Troy Clabaugh at email@example.com
to submit the proposed work dates and 24-hour contact information.
If you are requesting a 911 address, please contact the Planning Division at firstname.lastname@example.org and provide the
coordinates along with a site plan/location map of the small cell tower.