918 River Road
Cannon Falls, MN 55009
507-263-9300
dhoward@cannonfallsmn.gov
Utility Owner Contact Person Telephone Number
Electric________________________ ______________________________ _______________________________
Gas___________________________ ______________________________ _______________________________
Telephone_____________________ ______________________________ _______________________________
Other_________________________ ______________________________ _______________________________
Installer_____________________________________________ Project Coordinator__________________________
Address________________________________________________________________________________________
City_______________________________________________ State_____________________ Zip Code___________
E-mail__________________________________________________ Phone Number___________________________
Site Address:____________________________________________________________________________________
Type of Construction: __Overhead __Underground
Property Type: __Commercial __Residential
Activity: __New Construction __Repair
Nature of Work: ______________________________
____________________________________________
Size & Type of Pipe:___________________________
Method of Installation: __Plow __Trench __Bore
Length of Trench:____________________________
Depth from Surface:__________________________
Type of surface being disturbed:
__Concrete
__Bituminous
__Gravel
__Sod
__None
Excavation will be on:
__City Right of Way (deposit required)
__Private Property
__County Right of Way
__State Right of Way
Start Date:____________________________
Completion Date:______________________
Will Detour be required?
___Yes ___No
If yes, please describe route:____________
_____________________________________
_____________________________________
_____________________________________
I hereby acknowledge that this information is correct and that I agree to conform to the City Ordinances and State law
regarding this construction, and further agree to pay the permit fee. If at any time the City shall make improvements in
any part of the right-of-way which affects the utility, then the owner of the utility agrees to alter, change, move, vacate or
remove said utility to conform to such City improvements at the sole cost of the Utility company.
____________________________________________________________ ________________________________
Applicant’s Signature Date
Authorization of Permit
Permit Fee ($150.00): Date Pd:__________ Ck #_________
City Right of Way (Equal or Better) Restoration Deposit ($900.00): Date Pd:__________ Ck #_________
Copy of Certificate of Liability Insurance Provided (required): Yes____
Map of Project Provided (required): Yes____
Approved by:___________________________________________________ Date:___________________________
PERMIT
APPLICATION
FOR INSTALLATION
OF UTILITIES OR
FOR PLACING
UNDERGROUND
OBSTRUCTIONS
CONSTRUCTION INFORMATION
click to sign
signature
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Rules Pertaining to Street, Alley and Easement Excavations and Other
Public Right of Ways
Safety:
1. Notify Police, Fire, City Water and Street Departments at least 24 hours in advance except in the
case of emergencies prior to construction or street closingincluding all utility companiespublic
and private.
2. Excavations shall be properly protected and identified by barricades and flags in the daytime, red
lanterns or flashing signals at night, to protect persons and traffic at all times.
3. Barricades to be erected in a manner which will provide suitable visibility in all directions.
4. Excavations must be cribbed when necessary, depending upon type of soil in order to prevent
cave-ins.
5. No guys or stays to be attached to trees on right-of-way.
6. Underground construction must be so constructed as not to harm or unnecessarily destroy the roots
of trees.
7. Please provide the City of Cannon Falls with a copy of your certificate of liability insurance.
Roadway:
1. Installation of utilities under concrete or bituminous pavements to be done by jacking or boring
unless otherwise authorized by engineer. When an installation is made by jacking or boring a pipe
three inches or larger in diameter, a casing or larger dimension must be used to encase the service
pipe.
2. All back-filling must be placed in 6-inch layers and thoroughly tamped, and material must be flush
and even with the road surface when finally in place, unless Engineer authorizes alternate method
of construction. No rock, unstable soil, or bituminous material shall be returned to the backfilled
trench. All excavations must be backfilled and the surface restored to equal or better condition.
3. Finished surface, base and sub-base of road after excavation and back-fill, shall be at least equal in
stability to finished surface, base, and sub-base prior to excavation. A minimum 6” Class 5 gravel
base material shall be placed at the upper surface material and back-change the permit applicant.
4. Concrete pavement to be replaced according to MnDOT specifications which may be amended by
the City. Bituminous material to be replaced according the MnDOT specifications.
5. If settlement occurs or excavation caves in within one year from completion date so that replaced
materials settle (bituminous mat or concrete base); same shall be restored to its original condition
or better by the holder of this permit.
6. Excavations greater than four feet in width at top of trench will not be generally permitted and may
be made only when expressly provided on the permit.
7. Streets may not be closed to traffic unless expressly authorized by the permit and necessary
notifications have been made.
Limitations:
1. No lugs shall be used on equipment traversing road which will damage the road surface.
2. Roadside and/or site shall be cleaned up after work is completed.
3. No work shall be done which will create a nuisance.
4. Within 24 hours, (Saturday, Sunday & legal holidays excluded), the permit holder shall notify the
City Engineer or their representative who issued the permit and when applicable the County
Engineer that such work has been completed and is ready for final inspection.
5. No street excavations shall be allowed after November 15
th
of said year except for emergencies.