Excavation-Fill/ Work In R-W Permit Application Form
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1
2CITY OF TOLEDO PLANNING DEPARTMENT
EXCAVATION/FILL PERMIT APPLICATION
WORK IN THE RIGHT-OF-WAY PERMIT
Date _____________________
Permit Number __________________
Property Address _________________________________________, Toledo, OR Zone Designation _____________
Assessor's Map No. _____________________________ Tax Lot No. ___________ Lot Size ______________ sq. ft.
Property Owner(s) ______________________________________________
Phone __________________________
Address _________________________________________________________________________________________
Applicant's Name ______________________________________________
Phone __________________________
Address _________________________________________________________________________________________
Contractor No. _________________
Expiration Date ____________
Toledo Business Lic. No. ___________
Location of work to be performed ____________________________________________________________________
Describe work to be performed ______________________________________________________________________
1. Is this application associated with an existing land use or building permit application?
Yes ____ No ____
If yes, permit #__________________
2. Is an excavation/fill permit needed by Corps of Engineers/DSL?
Yes ____ No ____
3. Will the work take place in the public right-of-way?
Yes ____ No ____
If yes, will the work take place on Business Highway 20 or a designated truck route?
Yes ____ No ____
(special standards will apply for street cuts on the highway or truck route)
4. Is an engineer review required?
Yes ____ No ____
If yes, has an engineer approved plan been submitted?
Yes ____ No ____
5. If fill is removed, will it be located on a site that requires a Fill Permit?
Yes ____ No ____
If yes, where will fill material be located? ______________________________________________________
The following information is required with this application (2 copies of each drawn to scale):
A.
A Site Plan with the existing contours, proposed contours, cutting areas, filling areas, defined and showing
property lines and corner location (recorded survey if available).
B.
Include location and construction drawings for any retaining walls.
C.
Include profiles of any proposed cuts or fills.
D.
Include drainage plans showing impervious surfaces, direction of flow, any proposed containment,
facilities/areas and connection to the nearest public storm drainage system.
E.
Include a specific erosion control program and time line.
CALL BEFORE YOU DIG (1-800-332-2344): Oregon law requires you to follow rules adopted by the Oregon Utility Notification
Center. Those rules are set forth in OAR952-001-0010 through OAR952-001-0090. You may obtain copies of the rules by
calling the Oregon Utility Notification Center at (503) 232-1987 or at the City of Toledo Public Works Department. Note: OAR
Chapter 952 is in reference to underground utility requirements.
As part of this application, I agree to pay to the City of Toledo all costs, including a 20% charge for administrative overhead,
incurred for repair work performed by the City as a result of damage and/or clean-up by applicant's work to public right-of-way
surfaces or city utilities or other facilities. I agree to comply with all requirements as stated in Chapter 70 of the Uniform Building
Code. I further agree to comply with the requirements for the replacement of signs and barricades and for other safety measures
set forth in the Manual for Uniform Traffic Control Devices. I further agree to defend, indemnify, and hold harmless the City of
Toledo, its officers, agents, and employees from any and all claims for injuries to persons and damage to property arising out of
the work performed under this permit.
____________________________________________
_________________________________
Applicant
Date
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