VILLAGE OF ARLINGTON
STREET EXCAVATION PERMIT
Permit # ______________
Fee – $2000.00 total - $100.00 plus $1900.00 Escrow
The person, firm, or corporation named below has permission, subject to the conditions hereinafter set forth, to excavate within the
Village of Arlington at the location and for the type of installation hereinafter setforth.
Village Standards: All street work shall be performed in accordance with the current standard specifications for street openings found
in Section 6.06 and Section 6.07 of the Village of Arlington Code of Ordinances. Any damaged curb and gutter; sidewalk or grass
covered area shall be restored to the condition prior to damage.
Permit issued to: _______________________________________________________________________________
Address: _____________________________________________________________________________________
Telephone: ___________________________________________________________________________________
RESPONSIBLE PERSON IN CHARGE OF EXCAVATING:
Name: _______________________________________________________________________________________
Address: _____________________________________________________________________________________
Telephone: ___________________________________________________________________________________
LOCATION: _________________________________________________________________________________
TYPE OF INSTALLATION:
EXCAVATION SHOULD BE MADE IN ACCORDANCE WITH THE FOLLOWING CONDITIONS:
It is hereby provided and agreed that the above named party or parties to whom this permit is issued will do and perform all work in
connection therewith in a workmanlike manner, and will restore all areas according to the specifications as set forth by Village of
Arlington Code of Ordinances Sections 6.06 and Section 6.07. It is expressly provided that the person or persons for whose use may
benefit from this permit is not authorized to occupy said street right of way, except in conformity with provisions of the Ordinances of
the Village of Arlington, and by accepting this permit, be agreed that she/he will be liable for, and hold the Village of Arlington
harmless for any and all damages that may occur or result in consequences of the construction, excavation or occupancy of said street
right of way therein and shall put up and maintain such barriers as will effectively prevent the occurrence of any accident in consequence
of such occupancy, use or excavation of the street. The Applicant agrees to accept all stipulations set forth in Village of Arlington Code
of Ordinances Sections 6.06 and Section 6.07.
Written proof of public liability insurance of not less than $500,000.00 per one person, per one accident and $1,000,000 in property
damage coverage must be provided to the Village. A surety bond of no less than the actual cost of the proposed project plus 20% for
administration shall also be filed.
This permit is valid for a period of thirty (30) days from date of approval, except as provided for under Section 6.07(g) for pavement
replacement.
Dated: _________________________________________________
I have reviewed Village of Arlington Code
of Ordinances Section 6.06 and Section 6.07
and agree to the above conditions:
Approved by: ___________________________________________
Village Clerk or Public Works Superintendent
Applicant: ____________________________________
Signature
Certificate of Insurance rec’d __________________
Date: _____________________________