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DPW: Right of Way Permit Application

  1. taylor-button web only.jpg
  2. DPW
    City of Taylor 23555 Goddard Taylor, MI 48180
  3. This form is print only
    Please complete this form by signing in the respective field. Once signed please deliver or mail to the Department of Public Works at City Hall.
  4. This permit is incomplete until a Permit Number is assigned. This application/permit should be accompanied by a site plan or engineering drawing for the described area.
  5. Contact Information for Applicant
  6. Contact Information for Contractor
  7. Request: I do hereby make application for a permit to use the right-of-way of the following City street
  8. (In feet)
  9. Describe work to be completed and location in detail
  10. I certify that I accept the following*
    Commencement of work set forth in the permit application constitutes acceptance of the permit as issued. Failure to object to the permit as issued within ten (10) days constitutes acceptance of the permit as issued. If this permit is accepted by either of the above methods, I will comply with the provisions of the permit. If this permit is for commercial or residential driveway work, I certify that I am the legal owner of the property for which this driveway will serve, or I am the owner's authorized agent.
  11. Signature
  12. City of Taylor Use Only
  13. Survey Type
  14. Liability Insurance
  15. Leave This Blank: