Application for Trench Opening

2. Date
   Date

3. Application is Hereby Made by

4. Address

6. City

7. State

8. Zip Code

10. Emergency 24 Hour Phone

11. Maximum Width of Trench

    Feet Wide

12. Maximum Length of Trench

    Feet Long

14. Depth of Trench

    In Feet

15. County Road Name

16. County Road Number

18. Municipality

19. Block

20. Lot

22. Purpose of Laying

23. Size Pipe

    (Conduit, etc.)

25. Property of/Project Title

26. To Commence

    (Within 30 Days) Regulation #3 - Read Booklet "Time Limitations" Show Location on Sketch, Name Roads, Distance, etc.

28. Call 732-929-2124 (24 Hours Prior to Opening Road)
    
    The Applicant Shall Provide the 1-Call Damage Prevention System Confirmation Number Prior to Excavation

30. 

32. (Curb Line or Edge of Pavement) Road Shoulders / Right of Way are Part of Road
    Describe any Special Conditions

34. Final Surface Restoration Shall be as Follows:
    1. Mill across trench and extend 1' minimum beyond edges of trench to a depth of 1" minimum.
    2. Apply tack coat at a rate of 0.08 gallons per square yard.
    3. Place FA-BC surface course 1" thick minimum using paver at a minimum width of 8'.

36. Permit Fee Paid

37. Amount and Type of Bond Fee Received

    1. Cash
    2. Surety

39. Cash Amount

40. Surety Amount

42. The applicant agrees to accept the conditions of continuing County policy with regard to adjustment of utility structures. The applicant must agree that in the event of modification of the County road, utility adjustments necessary to meet the modification will be at the utility's cost and expense, and in addition, certifies receipt of the pamphlet entitled "Rules & Regulations for Openings," and understands their obligation for Road Openings.

    Signed

44. Date
    Date

45. Permit Number

46. Municipality

48. County Road Number and Name

49. Name of Applicant

51. You are hereby granted permission to make opening in County Road and perform work and install facilities therein in accordance with and subject to the conditions of you application, dated
    You are hereby granted permission to make opening in County Road and perform work and install facilities therein in accordance with and subject to the conditions of you application, dated

53. ...and in accordance with the plan and regulations attached, for service connection to property of

54. ...or construction or extension of

    Main or Conduits

56. Detailed statement of any special conditions or features: Lane/Shoulder Closings shall be between 9 a.m. - 4 p.m. Hot Mix Asphalt must be available on day of road opening.

58. Supervising Engineer

Leave This Blank:


60. Submit Submit and Print

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