MIDDLESEX COUNTY ROW Permit Package

PERMIT APPLICATION PACKAGE

I.                 ROAD OPENING PERMIT (ROP)

II.              HIGHWAY OCCUPANCY PERMIT (HOP) 

 

ROAD OPENING PERMIT (ROP)

 

ROAD OPENING PERMIT – INSTRUCTION SHEET

____________________________________________________________________________________________

 

“ALL CHECKS MUST BE CERTIFIED, BANK DRAFT, OR MONEY ORDER – NO EXCEPTIONS

 

CHECKS ARE TO BE MADE PAYABLE TO MIDDLESEX COUNTY TREASURER

(MUST BE SEPARATE CHECK FOR EACH LINE ITEM)

 

 

Purpose: This application is for activities requiring access to County Rights-of-Way for the installation or modification of facilities, or for other lawful purposes, and which requires excavation or disturbance of the County Rights-of-Way.

 

Application Fee – CHECK ONLY – NO CASH    $125.00 – Residential Permit

                                                                                      $250.00 – Non- Residential (including Utility Companies) Permit

 

Performance Bond: A performance bond is required on all excavations on County Roads in the amount equal to $75.00 per square yard of disturbance for each and every opening made in any concrete or bituminous concrete pavement and in the amount of $50.00 per square yard of disturbance for each and every opening in any other types of surfaces within County right-of-way. The terms “excavation” includes any opening or disturbance of concrete, bituminous or other impermeable surface in a County right-of-way, such as trenching for utility conduit and replacement of curbing for a development project.

 

Right-of-Way disturbance that does not involve the breaking or disturbance of bituminous surface, concrete or other impermeable surface within the Right-of-Way, but which may involve the disturbance of grass or soil, such as for the placement of a utility pole in the grass strip along a roadway, shall be exempt from the performance bond requirement, but shall comply with all other requirements of this application, including for fees for legal counsel review and inspections.

 

MINIMUM BOND AMOUNT - $10,000.00– PERFORMANCE BOND and application should be in the same name.

 

Note that this fee is waived if applicant has submitted an approved annual performance bond in lieu of bonds for each project. See section 34 of the Resolution to Protect County Roads for more details, including the minimum amount required for said annual bond.

 

Note that this performance bond requirement is waived for all Residential applicants.

 

 

Inspections Deposit: (i) Non-Residential Applications (including Utility Applications): A check for inspection fees is required and shall be in the amount of $1,000 for the first 7 days of a non-residential project, and an additional $500 for each additional 7 days required. For example, if a non-residential project is expected to take 16 days to complete, then a $2000 deposit for inspections is required. (ii) Residential Applications: A check for inspection fees is required and shall be in the amount of $500 for the first 7 days of a residential project, and an additional $500 for each additional 7 days required. For example, if a residential project is expected to take 9 days to complete, then a $1000 deposit for inspections is required.

 

Early Opening Pavement Degradation Penalty: An early opening pavement degradation penalty shall be required for opening any County road paved less than 5 years from the date of proposed excavation. The fee shall be determined as follows:

 

Year One (1) Base Minimum fee is $5,000.00 with the potential additional fee up to $10,000.00 based on the extent of the disturbance to the roadway to be determined at the discretion of the County Engineer

Year Two (2) Base Minimum Fee of $4,000.00

Year Three (3) Base Minimum Fee of $3,000.00

Year Four (4) Base Minimum Fee of $2,000.00

Year Five (5) Base Minimum Fee of $1,000.00.

 

This penalty may be waived, at the discretion of the County Engineer, if the applicant agrees to curb to curb restoration or 4’ either side restoration for transverse openings, or other such restoration acceptable to and in the best interest of the County.

 

The following is a non-exhaustive list of additional reasons the County Engineer may waive the Early Opening Pavement Degradation Penalty: (i) The County is already scheduled to resurface the affected road within a year of the proposed excavation, (ii) Due to its dimensions and extent, the County Engineer determines that a proposed excavation will have minimal impact on the integrity of the affected road, (iii) The excavation is part of a project that directly benefits or is sponsored by the County or is part of a maintenance arrangement with the County, and it is determined to be in the County's best interest to waive the fee. The final decision of whether or not to waive the fee, in light of conditions such as those referenced above, lies solely with the County.

 

No excavation permit shall be issued for openings, cuts, or excavations in the County Rights-of-Way for a period of five (5) years after the date of any repaving or resurfacing unless, in the judgment of the County Engineer and/or County Road Supervisor, an emergency exists which makes it essential that the Road Opening Permit be issued, or the permittee has demonstrated to the satisfaction of the County Engineer and/or County Road Supervisor that it has investigated all other alternatives and that the issuance of an Road Opening Permit is the only feasible option.

 

Legal Counsel Review Fee: All applications involving the placement or modification of telecommunications facilities are subject to an underlying compliance and entitlements review by the County’s legal counsel. A $500 fee shall be included with each application as a separate check, in addition to other required fees. Said consulting fee is required for each new utility pole, or other supporting structure, antenna, conduit, coaxial or fiber cabling, pipeline or other improvements and facilities requiring placement on, over or under the Right-of-Way, or county easements and properties, or modification, relocation and alteration to same.

 

 

Permit Duration: Permit expiration date shall be calculated as the total number of working days required to complete the project from a scheduled start date to complete construction and close out the project, but in no case longer than 30 days. Should work not commence at the proposed start date, the permittee is obligated to provide a written notification specifying a revised start date. If work does not begin by this revised start date and extends more than 21 days beyond the original scheduled start date, the permit shall expire. (Permittee is permitted one such written request to modify the proposed start date, with approval of said request being at the discretion of the County Roads Supervisor). To continue work beyond this period, the permittee must apply for a new permit, unless an extension is formally granted in writing by the Director of Public Works, or such authorized designee with the authority to grant an extension. All permits shall have a minimum duration of 7 calendar days. Permit must remain on site at all times.

 

All applications under advisement from the Middlesex County Planning Board, such as applications for site plan or subdivision approval which require a Road Opening Permit, may be required to comply with additional performance guarantee and other requirements, as determined by the Planning Board for the applicable application (see page 1, Section 6 of Resolution to Protect County Roads for more details).  ONLY plans pertaining to construction within the County right-of-way must be submitted with application.

 

Additional Permit Conditions:

 

Ø  The permittee must maintain vehicular and pedestrian traffic over the roadway within the scope of the project at all times in accordance with the MUTCD (Manual on Uniform Traffic Control Devices).

 

Ø  NEW JERSEY ONE CALL (1-800-272-1000) Reference No. ________________ must be given before Road Permit is issued.

 

 

Ø  Permittee must notify the Office of Public Works in writing at least FORTY-EIGHT (48) hours in advance of any land disturbance activity.  Likewise, the permittee must notify the Office of Public Works at the completion of the activity or project. A $1,000 fine will be assessed against the Permittee for each violation of this requirement.

 

Ø  Permittee shall also notify the Office of Public Works at least FORTY-EIGHT (48) hours in advance of any backfill to be performed. A $1,000 fine will be assessed against the Permittee for each violation of this requirement.

 

Ø  Restoration of the roadway must be completed within 90 days of completion of construction. During this time, the permit will remain open. Extensions for time to complete final restoration must be submitted in writing to the County DPW. If restoration is not completed within 180 days of completion of construction, the County reserves the right to file a claim against the applicant’s performance bond to cover any costs incurred by the County to perform any necessary work associated with the applicant’s failure to complete said restoration, including completion of required restoration work by the County.

 

If final inspection has not been requested within one (1) year from the date of permit – all or part of any deposits, escrows or other monies submitted along with the applicable application shall be subject to forfeiture to Middlesex County, with the County reserving the additional right to file a claim against the performance bond submitted in association with the applicable permit.

 

Ø  All work must be completed in accordance with the attached County Standard Details, as well as road construction and restoration details published by the NJDOT, as applicable.

 

Ø  Applicant must adhere to NJDOT standard traffic control details, when applicable.

 

Ø  Any and all detours require a resolution approved by all impacted municipalities prior to submission of permit application.

 

Ø  No Road Opening Permit will be issued until the proper Insurance Certificate is in this office.  (See page 1, Section 5 of Resolution to Protect County Roads, see last page for Sample of Certificate of Insurance).

 

Ø  Additional fines and penalties applicable to Road Opening Permits are as specified in the Resolution to Protect County Roads

 

Ø  IF PERMITTEE DOES NOT COMPLY WITH ABOVE REQUIREMENTS, IN ADDITION TO ANY FINES AND PENALTIES THAT MAY APPLY – SUCH NON-COMPLIANCE MAY RESULT IN THE COUNTY FILING A CLAIM AGAINST THE PEFORMANCE BOND.

 

For further information, please contact the Office of Public Works – Highway Division at (732) 940-6932. 

 

 

 


 

ROAD OPENING PERMIT APPLICATION

(To Be Filled in By Applicants)

Date                                                                      Contractor’s Email                                      ____________________                                _____________      

Application is hereby made by:                                                                                                                                                       (Name of Contractor)

Address                                                                                                                                                        Phone:                                            

Name of Owner: ___________________________________________________ Email                                        ____________________                                     

Address                                                                                                                                            Phone:                                                          

for the purpose of:     □ Laying pipe: size             □ Conduit          □  Curb            □  Shoulders                       □ Sidewalk                   □ Signal

or other                                                                                                                                                                                                                                                                  

to excavate trench                                             ft. wide                                 ft. long                                      ft. deep

on County Road                                                                 County Road No.                            Municipality                                                                                             

Lot No.                                                             Block No.                                         GIS Locations/Coordinates. __________________________ (Applicant shall submit location data in GIS format (e.g. Shapefile, GeoJSON, et al.), if such data is available to applicant).

NEW JERSEY ONE CALL (1-800-272-1000) - Reference Number                                                                              

Show location on sketch below, name roads, distances, etc.

 

 

 

 

 

 

 

Describe any special conditions:                                                                                                                                                                                      

 

Please provide the following dates (Maximum permit duration: 30 calendar days):

Proposed Start Date: ____________________________

Proposed End Date: _____________________________

 

Will the work require any lane closures or partial lane closures or any maintenance or protection of traffic requirements?  YES / NO

 

For how long will you be occupying the road? ______________________________________________________________________

 

What is your Traffic Control Plan? (Ex: police presence or other alternative) ______________________________________________

 

How will the site be secured over night?  __________________________________________________________________________

 

What is the 24/7 Emergency Contact Number for the Contractor on site? Name: ___________________________________   Number: ______________________

Permit charges are as follows: Non-Residential (including commercial and utilities): $250.00 – Residential: $125.00, in addition to fees specified in the Road Opening Permit form attached hereto. All of which shall be submitted with this application in the form of certified checks.

 

By signing this application the Contractor and Owner do hereby jointly and separately agree to abide by all rules and regulations that govern the work on any portion of Middlesex County Right of Way as more fully set forth in the enclosed current Resolution to Protect County Roads and providing penalties for violation thereof, which is part and parcel of this application.

SIGNED: (Contractor)                                                                                                                               

PRINT NAME                                                                                                                                            

SIGNED: (Owner)                                                                                                                                      

PRINT NAME                                                                                                                                            

 

 

 

 

 


 

ROAD OPENING PERMIT                                                                              No.____________

 

Permit No.: _________________             Municipality: ____________________________________         Date: ___________________________________

 

County Road No.: ____________            Name of Road: ____________________________________________________________________________

 

Name of Application: ________________________________________________________________________________________________________                 

 

You are hereby granted permission to make opening in County Road and perform work and install facilities therein accordance with and subject to the conditions of your Application, dated __________________________ and in accordance with the current resolution concerning road openings.

Purpose of Application: ______________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________      

All backfill must be done in accordance with the most recent County trenching spec.

Before excavation is to be started, phone: _______________________________________________________________________________________

Detailed statements of any special conditions or features: ___________________________________________________________________________

Size of Opening:____________________________________________________________________________________________________________

Location and GIS Coordinates: ___________________________________________________(Applicant shall submit location data in GIS format (e.g. Shapefile, GeoJSON, et al.), if such data is available to applicant).

Received Certified Checks in the amounts specified below to cover this permit.

$_______________________ (   ) NON-RESIDENTIAL: Received Permit Charge of $250.00

$_______________________ (   ) RESIDENTIAL: Received Permit Charge of $125.00

$_______________________ (   ) NON-RESIDENTIAL: Received Performance Bond

$_______________________ (   ) NON-RESIDENTIAL (INCLUDING UTILITIES): Received Inspection Fee ($1,000 for 1st 7 days, $500/week thereafter)

$_______________________ (   ) RESIDENTIAL: Received Inspection Fee ($500 for 1st 7 days, $500/week thereafter)

$_______________________ (   ) Received Early Pavement Degradation Penalty

$_______________________ (   ) Received Legal Counsel Review Fee (TELECOMMUNICATIONS ONLY)

$_______________________ (   ) Received Additional Fees, Deposit or Bond, as Required

$_______________________ (   ) Maintenance Bond, if Required. Specify amount. No. of Years _________

Permittee shall notify the Office of Public Works in writing at least forty-eight (48) hours in advance of any land disturbance activity.  Likewise, the Permittee should notify the Office of Public Works at the completion of the activity. Permittee shall also notify the Office of Public Works at least forty-eight (48) hours in advance of any backfill to be performed.

 

Permit expiration date shall be calculated as the total number of working days required to complete the project from a scheduled start date to complete construction and close out the project. Should work not commence at the proposed start date, the permittee is obligated to provide a written notification specifying a revised start date. If work does not begin by this revised start date and extends more than 21 days beyond the original scheduled start date, the permit shall expire. (Permittee is permitted one such written request to modify the proposed start date, with approval of said request being at the discretion of the County Roads Supervisor). To continue work beyond this period, the permittee must apply for a new permit, unless an extension is formally granted in writing by the Director of Public Works, or such authorized designee with the authority to grant an extension. All permits shall have a minimum duration of 7 calendar days and a maximum duration of 30 days. Permit must remain on site at all times.

 

                                                                                                                              SIGNED_________________________________________________________

 

REPORT (To be filled in by County Inspector)

 

Date of Completion:  ________________________________________________________________________________________________________

 

Type of Pavement Opening: ___________________________________               Width: _______________________  Length: _________________

 

Type of Shoulders Opening: ___________________________________               Width: _______________________  Length: _________________

 

Cost of Labor and Materials for repair of trench by County, if necessary.

 

Certified Checks/Bond Received: Permit Fee $________, Inspections $________, Performance Bond $________, Pavement Degradation Penalty

 

$_________, Legal Counsel  Fee (Telecommunications Only) $________, Maintenance Bond (if applicable): $________, Additional Fees $________

 

                                                                                                                              SIGNED _________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HIGHWAY OCCUPANCY PERMIT FORMS (HOP)

(NO ROAD OPENING)


 

 

HIGHWAY OCCUPANCY PERMIT – INSTRUCTION SHEET

____________________________________________________________________________________________

 

“ALL CHECKS MUST BE CERTIFIED, BANK DRAFT, OR MONEY ORDER – NO EXCEPTIONS

 

CHECKS ARE TO BE MADE PAYABLE TO MIDDLESEX COUNTY TREASURER

(MUST BE SEPARATE CHECK FOR EACH LINE ITEM)

 

 

Purpose: This application is for activities requiring highway occupancy (access and occupancy of the County Rights-of-Way) without the need for excavation or road disturbance, and which may include activities such as for the placement of banners, dumpsters or an oversize vehicle in County Rights-of-Way.

 

Application Fees: According to type of Highway Occupancy selected per the attached fee schedule

 

All applications under advisement from the Middlesex County Planning Board, such as applications for site plan or subdivision approval which require a Highway Occupancy Permit, may be required to comply with additional performance guarantee and other requirements, as determined by the Planning Board for the applicable application (see page 1, Section 6 of Resolution to Protect County Roads for more details).  ONLY plans pertaining to construction within the County right-of-way must be submitted with application.

 

Permit Duration: According to the type of Highway Occupancy.

 

Legal Counsel Review Fee: All telecommunications applications are subject to an underlying compliance and entitlements review by the County’s Legal Counsel. For example, applications for dumpsters, parades, street festivals, and oversized vehiclesare excepted from review. A $500 fee shall be included with each application as a separate check, in addition to other required fees as specified herein.

 

Additional Permit Conditions: The permittee must maintain vehicular and pedestrian traffic over the roadway within the scope of the project at all times in accordance with the MUTCD (Manual on Uniform Traffic Control Devices). In addition, applicant must adhere to NJDOT standard traffic control details, when applicable. Any and all detours must have a resolution approved by all impacted municipalities prior to submission of permit application.

 

 

IF PERMITTEE DOES NOT COMPLY WITH ABOVE REQUIREMENTS – THIS WILL RESULT IN THE COUNTY FILING  A CLAIM AGAINST ANY PERFORMANCE BOND SUBMITTED PURSUANT TO THIS APPLICATION

 

For further information, please contact the Office of Public Works Highway Division at (732) 940-6932. 

 

 

 

 

 


 

HIGHWAY OCCUPANCY  PERMIT                                                         No.____________

 

Permit No.: _________________             Municipality: ____________________________________         Date: ___________________________________

 

County Road No.: ____________            Name of Road: ____________________________________________________________________________

 

Date                                                                     

 

Application is hereby made by:                                                                                                                                                       (Name of Contractor or Applicant)

Address                                                                                                                                                        Phone:                                            

Name of Owner (if separate from applicant): ___________________________________________________ Email                                                  _________________

Address                                                                                                                                            Phone:                                                          

 

For the purpose of:     __________________________ (as selected on the attached Permit Form Checklist)

 

 

Name of Application / Project (if applicable. E.g. “1st Street Dumpster Placement”): ______________________________________________________    

 

Describe any special conditions in detail:                                                                                                                                                                        

___________________________________________________________________________________________________________________

 

Will the work require any lane closures or partial lane closures or any maintenance or protection of traffic requirements? YES / NO

 

You are hereby granted permission to occupy the County Road specified in the Application for Access in accordance with and subject to the conditions of your Application and any conditions specified on this permit, and in accordance with the current Resolution to Protect County Roads.

Permit charges are determined according to the type of Highway Occupancy selected per the attached fee schedule, and shall be submitted with this application. Escrow and performance bond amounts, if any, are determined according to the type of Highway Occupancy selected per the attached fee schedule, and shall be submitted with this application.

 

Received Certified Checks in the amounts specified below to cover this permit.f

$_______________________ (   ) Received Permit Fee

$_______________________ (   ) Received Additional Fees, Deposit or Bond, as Required

$_______________________ (   ) Received Legal Counsel Review fee, if Applicable (Telecommunications Only)

 

 

                                                                                                                              SIGNED_________________________________________________________

                                                                                                                              Print Name: ______________________________________________________

 

 

REPORT (To be filled in by County Inspector)

 

Proposed Start Date: ____________________________________________

Date of Permit Expiration:  _________________________________________________________________________________________________

 

Additional Conditions and Requirements:  ____________________________________________________________________________

 

________________________________________________________________________________________________________

 

________________________________________________________________________________________________________

 

________________________________________________________________________________________________________

 

Certified Checks/Bond Received: Permit Fee $________, Escrow $________, Legal Counsel Review Fee (Telecommunications Only) $________, Maintenance Bond (if applicable)

$________, Additional License/Recurring/Lane Closure Fees $_______________, Additional Fees $________

 

By signing this application the Contractor and Owner do hereby jointly and separately agree to abide by all rules and regulations that govern the work on any portion of Middlesex County Right of Way as more fully set forth in the enclosed current Resolution to Protect County Roads, and providing penalties for violation thereof, which is part and parcel of this application.

                                                                                                                              SIGNED_________________________________________________________

                                                                                                                             

HIGHWAY OCCUPANCY PERMIT – Permit Form CHECKLIST – Provide Additional Information Below, As Applicable

Select

Fee

Description

Comment/Conditions

[  ]

$125

Residential Dumpster

Dumpster Location: _________________________

Dumpster Size (cu yds): ________

Start Date: ____________

End Date: _______________

Additional $125 for every 10 day period beyond the initial 10 days. See below for additional fee if lane closure is required.

[  ]

$250

Utility/ Non-Residential Permit Dumpster

Dumpster Location: _________________________

Dumpster Size (cu yds): ________

Start Date: ____________

End Date: _______________

Additional $250 for every 10 day period beyond the initial 10 days. See below for additional fee if lane closure is required.

[  ]

$250

Equipment Storage

Equipment Location: __________________________

Equipment Size (e.g. cu yds, linear ft): ________

Storage Vessel Type/Description: _______________

Storage Start Date: _________________

Storage End Date: _______________

Flat fee. Applicant will utilize non-active, unused areas or areas typically used for parking, unless approved otherwise by the DPW. See below for additional fee if lane closure is required.

[  ]

$1,500

Filming on County Road

Filming Location: ________________

Start Date: ____________________
End Date: _______________________

Expected # Number of Cast/Crew: ______

Expected # of Vehicles: ______________

Additional Facilities (e.g. sets, temporary structures): ___________________

 

Daily rate, includes 1 street closure, intersection to intersection. Depending on the extent of the project and requirement for temporary structures, municipal construction permits may be required prior to issuance of a Highway Occupancy Permit for filming

[  ]

$100

Parades

Planned Route: __________________

Start Point: _____________________

End Point:______________________

Start Time: ________________

End Time: _________________

Time to Restore Route:__________

Staging / Assembly Area Required: _______

# of Attendees (approx.): _________

Additional Attendees (e.g. vehicles, animals etc.): ________________

Fee Waiver Requested? ( Y / N )

Reason for Fee Waiver Request: _____________________

 

Per 2 miles of county road, for duration less than an hour. May be adjusted at the discretion of the County Road Supervisor.

 

County review will include assessment of required detours, as applicable, and municipal authorization of same, if applicable.

[  ]

$200

Festivals

Type (e.g. block party, rally, street fair, cleanup): ________________

Location (e.g. primary street name, cross streets): ________________________

Start Time: _____________________

End Time: ______________________
Cleanup Duration:  ________________

Estimated Attendance: _______________

Additional Attendees (e.g. vendor trucks, animals, kiosks, tabling stands, DJ): ____________________

Non-Profit Affiliation (if applicable): ________________

Noise Standards Acceptance (initials): ____________

Municipal Approval Received?: ( Y / N )

Fee Waiver Requested? ( Y / N )

Reason for Fee Waiver Request: _____________________

 

$500 for the first day, $250 for each additional day of intersection to intersection street closure. Police presence may be required at the discretion of the County.

 

County review will include assessment of required detours and municipal authorization of same, if applicable.

[  ]

$250

Aerial Utility Work

Location of Work: ___________________

Attach Diagram, Traffic Control Plan, if Applicable

 

Per 1000’ linear feet. No disturbance to roads. See below for additional fee if lane closure and a Traffic Control Plan is required.

 

*Engineering review required

[  ]

$125

Banner Placement

Banner Location: ______________

Size of Banner (s.f.): ________________

Exact Wording on Banner: _______________

Start Date: _______________
End Date:  _______________

Attach Image, if Available

 

Per 12 s.f. of banner, up to 3 months occupancy. Temporary license, revocable by County Road Supervisor, at County’s discretion. See below for additional fee if lane closure is required during installation. Fee may be waived for municipalities at the discretion of the County Road Supervisor

 

*Engineering review required

[  ]

$350

Oversized Vehicle (> 200k lbs)

Proposed Route (Route Map): _____________________

Start Time: _______________________
End Time: _________________________

Vehicle Information: _____________________

Make: ___________________

Model: ___________________

Year: ___________________

VIN: ___________________

Driver License: ___________________

Vehicle Purpose (e.g. freight, hauling, oil): _________________

Requires NIDOT oversize vehicle permit, and route surveys.

 

Letter from a professional engineer required for the crossing of any County structure (e.g. bridge) certifying that the load of the oversized vehicle will not compromise the structural integrity of the applicable County structure.

 

$350 minimum fee, adjustable at the discretion of the County Road Supervisor

 

*Engineering review required

[  ]

$350

Oversized Vehicle (> 16' tall)

Proposed Route (Route Map): _____________________

Start Time: _______________________
End Time: _________________________

Vehicle Information: _____________________

Make: ___________________

Model: ___________________

Year: ___________________

VIN: ___________________

Driver License: ___________________

Vehicle Purpose (e.g. freight, hauling, oil): _________________

Requires NIDOT oversize vehicle permit, and route surveys.

 

Requires police escort and bucket truck lead. $350 minimum fee, adjustable at the discretion of the County Road Supervisor

 

*Engineering review required

[  ]

$500

Street Closure

Purpose: _________________________

Location (e.g. primary street name, cross streets): ___________________________________

Start Time: _____________________

End Time: ______________________
Cleanup Duration:  ________________

Municipal Approval Received?: ( Y / N )

Fee Waiver Requested? ( Y / N )

 

For purposes other than parade, festival and filming.

 

[  ]

$500

Small Wireless Facility

Existing Pole/Structure Location (e.g. coordinates, street address): _______________

New Pole Location (Note: Requires Road Opening Permit): _____________

$270 per year annual license fee

County Road Supervisor may require a Right-of-Way access license in addition to a  Highway Occupancy Permit

[  ]

$250

Strand Mounted Antenna

Location (e.g. coordinates, street address): ___________________

Position on Utility Pole: __________________

$150 per year annual license fee

County Road Supervisor may require a Right-of-Way access license in addition to a  Highway Occupancy Permit

[  ]

$200

Miscellaneous

Description: ________________________

Location: __________________________
Start Date: _________________________

End Date: ____________________________

 

Additional Information/Description:

____________________________________

__________________________________

__________________________________

 

Minimum. For non-disturbing access not described above. Adjustable at the discretion of the County Road Supervisor. See below for additional fee if lane closure is required.

 

 

 

 

 

Additional Lane Closure Fee:

 

Select

Fee

Description

Comment/Conditions

[  ]

$350

Lane Closure

Lane Closure Location: ___________

Start Time: ____________

End Time: ____________

Per lane, $350 for the first day. $150 for each additional day. Minimum fee when lane closure is required. Traffic control plan is required. Permittee must maintain vehicular and pedestrian traffic over the roadway within the scope of the project at all times in accordance with the MUTCD (Manual on Uniform Traffic Control Devices).