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2. CONTACT INFORMATION
4. Name of Applicant or Contact Person*
5. Name of Company Applicant Represents*
7. E-mail Address*
8. Phone Number*
10. Proposed Construction*
12. Location*
14. TYPE OF WORK/AGREEMENT
16. Work Required*
    -- Select One --Pavement CuttingCurb & GutterSidewalkBoringShoulder TrenchingOther
17. If "Other", please specify
19. Patching Required*
    -- Select One --PavementCurb & GutterSidewalkShoulderOther
20. If "Other", please specify
22. Upload pertinent documents
24. Acknowledgement
    It is understood and agreed by Applicant that upon approval of the application and the issuance of a construction permit that all pavement cutting, patching, and trenching inspections shall be accomplished in accordance with County requirements. Work shall not be commenced until the written approval is issued to Applicant and shall be completed before construction permit expires. "Grass or sod as needed for shoulder. All Lines to be constructed a minimum of 30" deep." Construction material /debris will not be used to fill in County Right of Way, backfill used for construction of drives, etc. will be clean fill. Short taps where water mains are on same side of pavement as tap-in will not require prior inspection. Applicant will be required to submit plans for work to be done.
26. Approval/Notice of Repairs
    If repairs to Right of Way are not made according to County standards by the expiration date shown on the permit, the County may elect to perform the repairs at Applicant's expense. Applicant agrees to promptly pay for such expenses. Applicant's failure to reimburse County for such expenses will be cause for Director to refuse to issue Applicant permits for future projects. County accepts no responsibility for and does not hereby warrant that it will protect, repair, of finish Applicant's project in the course of making such repairs to County Right of Way. Further, It is the responsibility of the “Applicant” to notify Santa Rosa County Road Department of the time and date this project will start. Please contact the Road Department via e-mail at PublicWorksAdminTeam@santarosa.fl.gov.
28. Acceptance of Terms
    Prior to clicking submit, "I certify that I have read the entire permit and agree to the terms stated herein."
32. FOR OFFICE USE ONLY
34. Permit Number:
35. Inspector Initials:
37. Approval Date:
38. Construction Permit Expires:
40. Permit Completion Date:
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43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

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