PERMIT TO WORK IN ROAD RIGHT-OF-WAY IN HAMILTON COUNTY, IOWA
1.
Hamilton County hereby authorizes the below listed contractor to work in the road right-of-way located:
2.
Township ____________________________
Section _____________________________
¼ Section ____________________________
Side of Road ________________________
Contractor to perform the work listed as specified by Hamilton County: _______________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
3.
CONTRACTOR
4.
LANDOWNER/TENANT
____________________________________
_________________________________
____________________________________
_________________________________
____________________________________
_________________________________
Phone # _____________________________
Phone # __________________________
5.
Hamilton County will inspect and approve site before and after construction.
6.
All work to be done as specified by Engineer as listed above.
7.
All work shall be done in a neat appearance and shaped in such a way that no water will run onto the
traveled portion of the roadway or disturb the traveled portion of the roadway.
8.
The contractor is to provide all signing and traffic control in accordance with the Manual on Uniform
Traffic Control Devices.
9.
If construction is not completed as specified above, the contractor will be given one opportunity to
make the necessary corrections within a ten day period or Hamilton County will make the necessary
corrections and bill all expenses to contractor.
10.
The contractor shall hold Hamilton County harmless for their actions and shall provide the county with a
certificate of insurance indicating coverage of the contractor for Public Liability Insurance in the amount of at
least $750,000.
11.
The contractor shall notify Iowa One Call at 1-800-292-8989 at least 48 hours prior to work and protect
existing utilities. The contractor is responsible for any damages as a result of their work in the right-of-way.
_________________________________________
(Contractor’s Signature)
(Date)
Date Permit Expires: _______________________
_____________________________________________
(Hamilton County Site Approval)
_____________________________________________
(Hamilton County Final Construction Approval)
7-14-06
(Date)
(Date)