2. Note:

   The approved permit MUST BE POSTED AT THE JOB SITE during the entire construction process. The permit expires at the project completion date & may be extended only upon submission of a written request to the Director of Public Works or his representative. No extension will be granted unless work has begun on the project.

5. Application Date*
   Application Date
7. Location of Work*
9. Description of Work*
11. Applicant/Contractor Name*
15. Project Start Date*
    Project Start Date
16. Project Completion Date*
    Project Completion Date
18. Applicant Address*
20. City*
21. State*
22. Zip Code*
24. Business Phone*
25. Cell Phone*
27. Contact Name*
28. Contractor's City of Daphne Business License #?*
30. Does scope of work impact a signalized intersection?

    (If no, leave blank)

    1. Yes
31. If "Yes," which intersection(s)?
33. Applicant's Digital Signature*
34. Date*
    Date
36. Email Address*

38. Application is hereby made to the City of Daphne, Public Works Department, in accordance with the most current City of Daphne Right-of-Way Ordinance for a permit to work within the public right-of-way at the above described location only, for the sole purpose as described above in the description of work. It is understood and agreed to by the Applicant that this permit is issued subject to the terms & conditions as stated below, AND all terms and conditions as stated in most current version of the most current City of Daphne Right-of-Way Ordinance.

40. 1. A sketch/drawing is hereby submitted depicting the scope of work to be performed, and complies with the most current City of Daphne Right-of-Way Ordinance.

41. Sketch/Drawing File Upload*

43. 2. The proper fee will be calculated by the most current City of Daphne Right-of-Way Ordinance, and payment (check or money order) to "The City of Daphne." No work will commence without payment of such fees.

45. 3. The required construction bond is uploaded here according to Appendix B, Section II of said Ordinance.
46. Construction Bond File Upload
48. 4. The Applicant hereby understands that the City of Daphne, Division of Public Works, reserves full & complete municipal control over the subject matter related to this permit.

50. 5. The Applicant understands that any violation of the most current City of Daphne Right-of-Way Ordinance, may lead to a stop work order & subsequent revocation of this permit. Further actions may be pursued in accordance with Section VII of this Ordinance.

52. 6. The Division of Public Works will perform inspections during the course of work stated in the above stated description of work. Final Inspections will be scheduled with Public Works in accordance with Appendix B, Section IV of the most current City of Daphne Right-of-Way Ordinance.

54. 7. The Applicant agrees to notify the Public Works Director or his representative twenty-four (24) hours prior to starting work on any major or minor projects and seventy-two (72) hours prior to closing any roadway or interruption of traffic flow. The applicant must contact the Public works director or his representative for an inspection when the work is complete.

56. 8. The Applicant agrees to restore the general area of work including disturbed landscaping, sodding, paving, etc., per the City of Daphne construction standards and the specifications of the Public Works Director.

58. 9. This permit is rendered invalid if work is not initiated within six (6) months or if the project lies dormant for a period of thirty (30) days after starting construction.
62. For Internal Use Only
Leave This Blank:


67. 1. Receive an email copy of this form.
68. Email address

    This field is not part of the form submission.

69. Submit Submit and Print

* indicates a required field