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Application for Township Road Occupancy Permit

  1. (Where work is to be done)

  2. Application is hereby made by:
  3. Under and subject to all the conditions, restrictions, and regulations prescribed by the Township and on the general provisions and specifications, a true copy whereof is attached and made a part hereof, with the same force and effect as if written printed herein and under and subject to the special conditions, restrictions, and regulations hereinafter set forth.
  4. Data Applicable to this Application
  5. GENERAL
  6. Number of Poles to be Erected:

  7. Approximate area of openings in improved surface: _____ square yards. 

    Do not answer if this does not apply to your application. 

  8. Approximate area of openings on unimproved part: _____ square yards.

    Do not answer if this does not apply to your application.

  9. Length of trench along the road: ______ feet.

    Do not answer if this does not apply to your application.

  10. Depth of trench below surface: _______ inches.

    Do not answer if this does not apply to your application. 

  11. Screenshot 2023-06-20 at 12.22.13 PM
  12. Please upload your image, sketch, or document to accompany your application.

  13. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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  15. This field is not part of the form submission.