DPW Work Permit Application DPW Work Permit "*" indicates required fields Step 1 of 5 20% Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Permit Type*WaterSewerDrainageStreet/SidewalkDumpsterInsurance CertificateMax. file size: 2 GB.Sketch(es)* Drop files here or Select files Max. file size: 2 GB. Sketch(es) Drop files here or Select files Max. file size: 2 GB. Location* Date* MM slash DD slash YYYY Project Start Date* MM slash DD slash YYYY Project End Date* MM slash DD slash YYYY Underground*N/AGasWaterElectricTelephoneSewerSignalsOn Ground*N/ACurbSidewalkPavementEquipmentScaffoldsStorageDumpsterAbove Ground*N/APole MaintenanceTree Removal Protective Liability InsuranceCompany* Policy Number* Effective Date* MM slash DD slash YYYY Expiration Date* MM slash DD slash YYYY Notice I agree to the below:The Permittee will notify the department of public works @ 797-3031 (6 am - 2 pm) and/or the water department @ 797-2523 (7 am - 3 pm) prior to backfilling for inspection. The Supervisor reserves the right to suspend or revoke this permit, at his discretion without a hearing or the necessity of showing cause, either before or during the operations authorized. This permit will remain on the project until all work covered under this permit is completed in accordance with the terms set forth by the Dept. of Public Works. Identification of Permittee must be clearly displayed on the project site. Permission is hereby granted subject to the provisions and conditions set forth by the Dept. of Public Works.Signature*Date* MM slash DD slash YYYY Untitled EmailThis field is for validation purposes and should be left unchanged. Δ Pay your water, sewer and refuse payment online. Pay Online
