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2. Project Location*
4. Permitee
   Property owner, utility company, contractor, etc.
6. Company Name
8. First Name*
9. Last Name*
11. Address*
13. City*
14. State*
15. Zip*
17. Phone*
18. Home Phone
19. Cell Phone
23. Contractor Information
25. Contractor Name*
27. Address*
29. City*
30. State*
31. Zip*
33. Phone*
34. Home Phone
35. Cell Phone
39. Utility Installation Information
41. Type of Utility Installation*
42. Name of Plan Prepairer*
44. Utility Proposed To:*

    1. Cross Right of Way
    2. Parallel Right of Way

    1. Underground
    2. Overhead
45. Proposed Method of Installation*
    -- Select One --Open CutJack and BoreTrenchPlowTunnelCasedSuspended on PolesSuspended on Towers
47. Estimated Start Date*
    Estimated Start Date
48. Estimated Restoration Date*
    Estimated Restoration Date
52. Permit Information
    Maintenance of the permit opening is the responsibility of the property owner/agent. After notification by the City, the property owner/applicant has twenty-four (24) hours to respond to a request of maintenance. If no response to the City is made by the property owner/applicant, the City will maintain the permit opening and bill the property owner/applicant.
    
    The property owner/applicant understands and agrees that the permitted work shall comply with all permit provisions and conditions listed on the reverse side hereof, any special provisions listed below or attached hereto, and any and all plans, details or notes attached hereto and made a part hereof.
54. Submit Payment
    Permit will not be processed until $130 payment is received. Please mail or drop off payment to:
    City of River Falls Right of Way Permits
    222 Lewis St., Suite 225
    River Falls, WI
56. Approval of Provisions and Conditions*

    1. By clicking here I certify that I have read, understand, and agree to the Permit Provisions and Conditions
58. Owner / Applicant Signature*
59. Date*
Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field