LAND USE PERMIT
LUP-PRU
Land Use Permit Application – Prior Rights Utility
August 26, 2014
APPLICATION is hereby made for a prior-rights permit allowing existing utilities to remain in place within state
maintained rights-of-way. Applicants to whom permits are issued shall at all times indemnify and save harmless the
Commonwealth Transportation Board, members of the Board, the Commonwealth and all Commonwealth employees,
agents, and offices, from responsibility, damage, or liability arising from the exercise of the privileges granted in such
permit to the extent allowed by law. A prior-rights permit is only to be issued for a utility that does not conflict with
highway or entrance improvement construction to be started within a year of permit issuance.
APPLICANT SHALL RECEIVE A PRIOR-RIGHTS PERMIT AT NO COST
TYPE OR PRINT CLEARLY
Utility Company Name: ______________________________________Federal Tax ID No. __________________________
Address: _________________________________________________________________________________________
City: __________________________________________________________ State: _______ Zip Code: ____________
Contact Name: _________________________________________ E-mail Address: _____________________________
Telephone No.: ( _____ ) _______-______________
Fax Number: ( _____ ) _______-______________
Type of Utility: ___________________________________________________________________________________
Existing utility geographically located in County / Town / City of: ____________________________________________
On Highway Route No.: _______________ between Route No.: _______________ and Route No.: __________________
Applicant’s Signature: ____________________________________ Title: ____________________ Date: ____________