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3. Name of Applicant*
4. Firm Represented
6. Mailing Address*
8. City*
9. State*
10. Zip Code*
12. Phone Number*
    555-555-5555
13. Email Address*
15. Describe Work in Detail*
17. Right-of-Way Closure Location*
    Street/Avenue/Drive, etc.
19. Dates of Closure*
    Dates of Closure Start Date

    —

    Dates of Closure End Date
    Final dates determined by Engineering Department
21. Sketch of Work or Other Attachments
    Upload Image or Documents
23. Applicant Signature*
    By typing my name I am electronically signing this application.
25. Please read the following:
    First: The Applicant represents all parties in interest and shall furnish material, do all work, pay all costs, and shall in a reasonable length of time restore the damaged portions of the right-of-way to a condition similar or equal to that existing before the commencement of the described work, including any seeding or sodding necessary.
    
    Second: The proposed work shall be located and constructed to the satisfaction of the Town Engineer or his duly authorized representative. No revisions or additions shall be made to the proposed work on the right-of-way without the written permission of the Town Engineer.
    
    Third: The Applicant shall at all times conduct the work in such a manner as to minimize hazards to vehicular and pedestrian traffic. Traffic controls and work site protection shall be in accordance with the applicable requirements of Chapter 6 (Traffic Controls for Highway Construction and Maintenance Operations) of the Illinois Manual on Uniform Traffic Control Devices for Streets and Highways and with the traffic control plan if one is required elsewhere in the permit. All signs, barricades, flaggers, etc., required for traffic control, shall be furnished by the Applicant. The work may be done on any day except New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day. Work shall be done only during daylight hours.
    
    Fourth: The work performed by the Applicant is for the bona fide purpose expressed, and not for the purpose of, nor will it result in, the parking or servicing of vehicles on the street right-of-way. Signs located on or overhanging the right-of-way shall be prohibited.
    
    Fifth: The Applicant, his successors or assigns, agrees to hold harmless the Town of Normal and its duly appointed agents and employees against any action for personal injury or property damage sustained by reason of the exercise of this permit.
    
    Sixth: The Applicant shall not trim, cut, or in any way disturb, any trees or shrubbery within the right-of-way without the approval of the Director of Parks and Recreation or his duly authorized representative.
    
    Seventh: The Town reserves the right to make such changes, additions, repairs and relocations within its statutory limits to the facilities constructed under this permit or their appurtenances on the right-of-way as may at any time be considered necessary to permit the relocations, reconstruction, widening or maintaining of the street and/or provide proper protection to life and property on or adjacent to the Town right-of-way. However, in the event this permit is granted to construct, locate, operate and maintain utility facilities on the Town right-of-way, the Applicant, upon written request by the Town Engineer, shall perform such alterations or change of location of the facilities, without expense to the Town, and should the Applicant fail to make satisfactory arrangements to comply with this request within a reasonable time, the Town reserves the right to make such alterations or change of location or remove the work, and the Applicant agrees to pay for the cost incurred.
    
    Eighth: This permit is effective only insofar as the Town has jurisdiction and does not presume to release the Applicant from compliance with the provisions of any existing state and federal statutes or regulations relating to the construction of such work.
    
    Ninth: The construction of access driveways is subject to the regulations listed in Chapter 8 of the Town of Normal Municipal Code. If, in the future, the land use of property served by an access driveway described and constructed in accordance with this permit changes so as to require a higher driveway type as defined in that, the owner shall apply for a new permit and bear the costs for such revisions as may be required to conform to the regulations listed in the Municipal Code. Utility installations shall be subject to provisions in the Manual of Practice for the Design of Public Improvements in the Town of Normal.
    
    Tenth: The Applicant affirms that the property lines shown on the attached sheet(s) are true and correct and binds and obligates himself to perform the operation in accordance with the description and attached sketch and to abide by the policy regulations.
27. I have read the above disclaimer*

    1. Yes
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

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