Fillable Washington County Commonwealth of Pennsylvania 3599 Millers Run (Cecil Township PA)

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Washington County Commonwealth of Pennsylvania 3599 Millers Run (Cecil Township PA)

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Country of origin: US
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U.S.A. forms for Cecil Township PA

BROWSE CECIL TOWNSHIP PA (PA) FORMS

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Washington County – Commonwealth of Pennsylvania
3599 Millers Run Road, Suite 101, Cecil, PA 15321
Phone: (724)745-2227 • Fax: (724)745-2905 • Web: www.ceciltownship-pa.gov
Cecil Township
APPLICATION FOR TOWNSHIP ROAD OCCUPANCY PERMIT
___________________________________________________ DATE: ____________________________________
(Route Number, Road or Street where work is being done) INVOICE: _________________________________
Application is hereby made by: ________________________________________ Permit Fee: $ ___________________________
(Name of Applicant) Inspection Fee: $ ___________________________
Address: ___________________________________________________________ Total: $ ___________________________
City: ______________________________________ State: ____________________ Zip: ________________________
Attention: __________________________________________________________ PA One Call #: _____________________________
Description of work: _________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Under and subject to all the conditions, restrictions, and regulations prescribed by the township and on the general provisions and
specifications, a True Copy, hereof is attached and made part thereof; with the same force and effect as if written or printed herein and under
and subject to the special conditions, restrictions, and regulations hereafter set forth.
General:
Approximate date work will start:_________________________ Approximate date work will be complete:_________________________
Road surface is improved to a width of______________feet. Distance from centerline of road to right-of-way:______________feet.
Poles and Tower:
Number of poles to be erected:__________ Nearest distance from center of road to structure:__________feet. Distance of proposed
work along road:__________feet.
Pipelines and Conduits:
The improved surface of the road__________be opened. Approximate area of opening in improved surface:__________square feet.
Approximate area of openings on unimproved part:__________square feet. Length of trench along road:__________________ feet.
TO BE COMPLETED BY TOWNSHIP
Schedule Item No.
Unit Fee
Number of Units
Total Fee
The applicant is ________________________________________ incorporated under the law of _________________________________.
Name of Applicant: ____________________________________________________________ (Corporate Seal)
Representative: ________________________________________ Email: ____________________________________________
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Washington County Commonwealth of Pennsylvania 3599 Millers Run (Cecil Township PA)

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Completed 18 January 2021

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