Application For Highway Permit - City Of Walker printable pdf download

City of Walker

Michigan

APPLICATION FOR HIGHWAY PERMIT

APPLICATION No…………………………………………………………….Date……………20…………….

Road Name ………………………………………………………………….Width of R.O.W. ……………….ft.

Location of the Work ……………………………………………………………………………………………..

Owner ………………………………………………….. Address………………………………………………

Contractor……………………………………………… Address………………………………………………

Applicant ……………………………………………….. Address………………………………………………

Permission is requested to do the following work within the limits of the highway and it is hereby

agreed to do this work in accordance with the “Specifications and Conditions” of the City of Walker.

Detailed sketches of the work will be supplied when requested.

………………………………………………………………………………………………………………………

Work to commence………………………20…………., and to be completed………………………, 20 ……...

The undersigned further agrees that if this application is approved he will meet all legal requirements

and that he will be responsible to the City of Walker for any damages to the highway or highway

structures or to the structures of any private company within the right-of-way of the highway,

and that he shall well and truly pay all damages, fines and penalties which he shall become liable

to pay and shall save the City of Walker harmless from all suits, claims, damages and proceedings

of any kind due to his operations within the highway.

Signature of Applicant……………………………………..For …………………………………………………

Approved by……………………………………….. of Maintenance Dept. Date ……………………………..

Approved by ………………………………………. of Building Dept.

Date ……………………………..

Approved by ………………………………………. of Engineering Dept. Date ……………………………..

Application For Highway Permit - City Of Walker