Right-of-Way Construction Permit - About Larimer County

(Please Print)Applicant:Right-of-WayConstruction PermitLarimer CountyEngineering Department200 W. Oak St, Ste 3000PO Box 1190Fort Collins CO 80522-1190Phone: (970) 498-5700Fax: (970) 498-79865 Working Days Required for Review of PermitContractor:County Use Only:DistrictCounty RoadFee: $Paid: Check#:Name/ CompanyName/ CompanyMailing Address Cell Phone Mailing AddressCity State Zip City State ZipPhone Fax Phone FaxE-mail Address (if applicable)E-mail Address (if applicable)Utility Company Work being done for: (if applicable) Work Area:NameMailing AddressAddressNearest County Road IntersectionCity State Zip County Road Work Order Number SubdivisionPhone Fax Section Township RangeSchedule: Begin EndConstruction Plans and Traffic Control Plan are RequiredCounty Use OnlyWork Hours: Plans Attached: Yes No Road Closure: Yes NoInspector Assigned: Yes No Existing surfacing: Asphalt/ Chip Sealed Treated Gravel Non-Treated GravelTraffic Control Plan Submitted: Yes No Applicant shall pay for inspection fees: Yes NoFinal Inspection required: Yes NoFees:Admin. Fee: $Lineal Footage Fee: $Overhead Fee: $Open Cut Fee: $Total Fees: $Standard Special Provisions:Total Footage for ProjectPermit Void After This DateYesNoOpen cut in roadway approved.Road crossings shall be bored.Flow fill required in excavation.The backfill material shall be approved, tested and compacted to AASHTO T99 or T180 soil standards. (as applicable)All potholes will be core-drilled, flow filled and vibrated. Pothole shall be tacked and have inches of HBP in hole.If the final asphalt repair is delayed three inches of cold mix is required in excavation prior to opening to traffic.Asphalt repair depth shall be inches thick.Strip and separate the topsoil from the backfill material, then replace topsoil after the excavation is complete.Reseed all disturbed areas with approved County seed mix.Call 48 hours prior to commencing work at (970) to schedule inspections.Special Provisions:Call (970) 498-5709 For Final Inspection - 72 Hours Notice RequiredIn accepting this permit the undersigned, representing the Applicant, certifies that he or she has read and understands all of the foregoingprovisions; that he or she has authority to sign for and bind the Applicant; and that by virtue of his or her signature the Applicant is bound byall the conditions set forth herein.Applicant’s Signature Date Application Approved by Larimer County DateEngineering DepartmentLarimer County Completion SignatureDateWhite – Office Yellow – Inspector Pink – Applicant LCE – 360 (10/02)

General Provisions1) Applicant shall be responsible for establishing safety measures sufficient to protect the traveling public from any and all harm during utilityconstruction, improvement, location, or relocation.2) Facilities shall be placed in a location mutually agreed upon by Applicant and Larimer County and in accordance with details and specifications shownon the construction plans.3) Applicant shall inform Larimer County of construction methods, equipment and operational procedures that will be utilized and obtain the County’sconcurrence.4) Applicant shall advise Larimer County 48 hours in advance of the date work will be started and shall notify Larimer County a minimum of 12 hours inadvance if this date is changed.5) Applicant shall be responsible for any repairs necessary as a result of such installation. The maintenance responsibility of work repairs shall be anobligation of the Applicant for two years after final acceptance of the work by the County.6) Clearing of trees, bushes and other vegetation shall be held to the minimum required for construction and safety.7) Applicant shall return right-of-way to its original condition, as near as practicable, and shall remove all rubbish and debris following completion ofconstruction and before final inspection by the County and Applicant. If final inspection determines additional corrective measures necessary, suchcorrective measures shall be initiated within 30 days and completed by applicant within a reasonable interval of time considering the circumstances.8) Applicant shall hold Larimer County officers and agents harmless from any and all claims which may arise from the construction and maintenance ofApplicant’s facilities covered by the permit.9) In the event any changes are made to this roadway in the future that would necessitate removal or relocation of this installation, applicant will do sopromptly at its own expense upon written request from Larimer County, Colorado. Larimer County, Colorado, will not be responsible for any damagethat may result to said installation in the normal maintenance of the highway or to the installation placed inside County right-of-way limits.10) Work must be preformed in compliance with all applicable federal, state and local regulations.White – Office Yellow – Inspector Pink – Applicant LCE – 360 (10/02)