Form Center

4. Right-OF-Way Construction/Use Permit Application

6. Application No: ______

7. _____ Fee: $10.00

9. Date:
   Date:
11. Name
12. Email Address
14. Address
16. City
17. State
18. Zip Code
20. Phone Number
22. Location Address:
24. Legal Description:
26. Contractor:
27. Email Address
29. Contractor Address
31. City
32. State
33. Zip Code
35. Contractor Phone Number:
37. Description of Work:

    1. Construction
    2. Repair

    1. Widen
    2. Replace

    1. Plant
    2. Place

    1. Install
    2. Other
39. If other explain:
41. For:

    1. Driveway
    2. Sidewalk
    3. Curb Cut

    1. Service Line
    2. Culvert
    3. Vegetation

    1. Lighting
    2. Sprinkler System

    1. Ornamental Structure/Mailboxes
    2. Other
43. If other explain:
45. Distance from Intersection:
47. If curb cut for driveway will driveway be paved?

    1. Yes

    1. No

    1. Unknown
49. Council Approval

    1. Yes
    2. No
51. Date Council Approved
53. Brief description of proposed project:
55. Estimated date of Completion:
56. Estimated Cost of Construction:
58. A SITE PLAN AND DRAINAGE PLAN OR WRITTEN ASSURANCES THAT DRAINAGE WILL NOT BE A DETRIMENT TO NEIGHBORING LANDS MAY BE REQUIRED WITH THIS APPLICATION

    I swear to the best of my knowledge that the information here given and any attached materials are true and complete and that the work done will be in the accordance with the Fairbury Municipal Code, the Zoning and Subdivision Regulations, and the adopted Building, Fire, Electrical and Plumbing Codes. Furthermore, I agree to be responsible for repair and/or replacement of any and/or all deficient work and damages caused by said deficient work within two (2) years from the tie for issuance of this permit.

60. 
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit Submit and Print

* indicates a required field