Street Opening and Right-of-Way Permit Application

2. Office Use Only: Permit Number

4. Street Opening and Right-of-Way Permit
   All restoration work shall be guaranteed for a period of one year after completion and official acceptance in writing of same. If the repair is still in compliance after the one-year guarantee period, the deposit may be refunded per Sec. 42-3(d)(3). Public utilities are exempt from deposits and permit fees according to Sec. 42-3(b)(2).

   All restoration work shall be guaranteed for a period of one year after completion and official acceptance in writing of same. If the repair is still in compliance after the one-year guarantee period, the deposit may be refunded per Sec. 42-3(d)(3). Public utilities are exempt from deposits and permit fees according to Sec. 42-3(b)(2).

5. You are applying for a...*

   1. Street Opening
   2. Right-of-Way

7. Property Owner*

8. Phone Number*

10. Address of Opening*

11. Email Address*

13. General Contractor*

14. Phone Number*

16. Address*

17. Email Address*

19. What is the purpose of the opening?*

20. What is the size of the opening?*

22. Sketch of Opening

    (If opening exceeds 20 sq. ft. or 30 ft. in length, sketch required)

23. Deposit*

    1. I understand that the required deposit and fees must be paid before I will be approved for this permit.*

    *If deposit and fees are not received within a timely manner, permit requests may be denied.

25. Erosion Control Permit Required*

    1. Yes
    2. No

    If you are unsure, please contact City Hall.

26. 

28. Certificate of Insurance

    Applicant must submit evidence that they are covered by public liability insurance in the following minimum amounts and that such insurance protects the city from all claims; personal injury: property: one person, one accident - $1,000,000.00, $1,000,000.00, $500,000.00. The evidence of insurance shall also provide that the city be notified at least ten days prior to cancellation or expiration of the insurance.

30. Regulations Governing Street Opening and Right-of-way Opening Permits
    Regulations Sheet

    Please download and read carefully. Certify below that you have read these regulations

32. Certification of Regulations

    1. I certify I have read the Regulations Governing Street Opening and Right-of-way Opening Permits in the City of Delafield in its entirety. I further agree to comply with these regulations.

34. Fee
    The minimum fee is $75.00 - additional charges are common. Please call the City Clerk's Office at (262) 646-6220 when determining the final fee. The fee chart is shown above. Credit Cards are accepted. Convenience fee applies.

    The minimum fee is $75.00 - additional charges are common. Please call the City Clerk's Office at (262) 646-6220 when determining the final fee. The fee chart is shown above. Credit Cards are accepted. Convenience fee applies.

36. By Submitting this Form
    You understand you are required to comply with all City rules, regulations, and ordinances, pertaining to street opening and/or right-of-way opening. Any damage to City property will be the responsibility of the homeowner or permit holder. Approved permits are valid for 60 days from the date of issuance unless a time extension is granted by the Director of Public Works.

    You understand you are required to comply with all City rules, regulations, and ordinances, pertaining to street opening and/or right-of-way opening. Any damage to City property will be the responsibility of the homeowner or permit holder. Approved permits are valid for 60 days from the date of issuance unless a time extension is granted by the Director of Public Works.

38. For multiple excavations within the current calendar year, an applicant, may in lieu of the above, provide an annual deposit of $10,000. Such deposit shall at all times be maintained at $10,000.00.

    For multiple excavations within the current calendar year, an applicant, may in lieu of the above, provide an annual deposit of $10,000. Such deposit shall at all times be maintained at $10,000.00.

Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field