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2. Application Fee: $165

4. Section 1: Applicant Information
6. Contact Name*
7. Company Name*
9. Phone Number*
10. Email Address*
12. Billing Address*
14. City*
15. State*
16. Zip Code*
18. Project Number (if applicable)
22. Section 2: Contractor Information
24. Contact Name*
25. Company Name*
27. Phone Number*
28. Email Address*
30. Billing Address*
32. City*
33. State*
34. Zip Code*
38. Section 3: Construction Information
40. Type of utility*
42. Description of proposed work*
46. Section 4: Location Information
48. Address or Street*
49. Nearest intersection*
51. Starting Point*
52. Ending Point*
56. Section 5: Excavation Information
58. Type of excavation
    -- Select One --TrenchHoleBoreOther
60. Excavation size (width in feet)
61. Excavation size (length in feet)
63. Disturbed area
    -- Select One --Driving laneParking lane Sidewalk/PathBoulevard
64. Type of surface disturbed
    -- Select One --AsphaltConcreteGrassOther
68. Section 6: Obstruction Information
70. Right-of-Way obstruction type
    -- Select One --Driving laneParking laneSidewalk/PathBoulevard
72. Obstruction size (width in feet)
73. Obstruction size (length in feet)
77. Section 7: Construction Schedule
79. Excavation dates
    Excavation dates Start Date

    —

    Excavation dates End Date
80. Obstruction dates
    Obstruction dates Start Date

    —

    Obstruction dates End Date
82. Hours of obstruction
    Hours of obstruction Start Time

    —

    Hours of obstruction End Time
86. Disclaimers
88. Do you agree to these terms*

    1. Yes

    The applicant in carrying on any and all of the work above mentioned or referred to in its application and in the permit issued therefore, shall strictly conform to the terms of such Permit, and the regulations of the City of New Brighton. The applicant shall also comply with the regulations of all other governmental agencies and perform the work in a manner that will not be detrimental to the right-of-way and that will safeguard the public.

90. Do you agree to these terms*

    1. Yes

    Excavators are required to notify the pipeline operator immediately if their work damages a pipeline and to call 911 or other local emergency response number immediately if the damage results in a release of natural gas or other hazardous substance or potentially endangers life, health, or property.

92. Acknowledgement*

    1. Yes

    I (the applicant/company) hereby acknowledge that I must adhere to the City of New Brighton Right-of-Way Ordinance Number 661 and all its provisions.

94. Digitally signed by (enter name in box)*
98. Plans
100. Upload plans*

     Attach 1 set of Engineer grade construction plans (11 inches by 17 inches) to the application.

102. Payment

     Upon submission you will be directed to the payment page. 

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104. Submit

* indicates a required field