VILLAGE OF CALEDONIA
DITCH MODIFICATION APPLICATION
($45.00 per hour/minimum two hours)
Project Address: Date: :
Lot: Block: Subdivision: :
Parcel Id #: :
Name of Applicant: Applicant’s Telephone: :
Address of Applicant: :
Name of Mortgagee: :
Mortgagee’s Telephone: :
Address of Mortgagee: :
Estimated Cost of Ditch Modification: :
Name of Design Engineer/Inspector: :
Size of Driveway Culvert:
Size of Upstream Culvert:
Size of Downstream Culvert:
Length and Description of Area Proposed to be modified:
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(Applicant to supply Drawings of installation with cross sections)
Name of Installation Contractor: :
Contractor’s Insurance Carrier: :
Hold Harmless Agreement Signed: Yes: No:
Conditions
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:
:
:
:
:
Signature of Applicant
Village Engineer’s Signature
Date Approved:
Date Installed: Date of Backfill Inspection: Pass Fail By:
Date of Final Grading Inspection: By:
P:\ENGINEER\Ditch Enclosures\Partial\2014\DitchModifcationAgreement2014.doc
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