2. Note:
   This permit must be filed within seventy-two (72) hours of the initiation of emergency work within the City Right of Way.
4. Applicant Name*
6. Applicant Address*
8. City*
9. State*
10. Zip Code*
12. Business Phone*
13. Cell Phone*
14. Email Address*
16. Location of Work Address*
18. City*
19. State*
20. Zip Code*
22. Description of Work*

24. The Emergency (After-the-Fact) Emergency Right of Way (ROW) Application is hereby made to the City of Daphne, Public Works Division, 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 the most current City of Daphne Right-of-Way Ordinance.

26. 1. A sketch/drawing may be required depicting the extents and type of work performed, and will comply with Appendix B of the most current City of Daphne Right-of-Way Ordinance.

28. 2. Fees are charged for repairs and/or maintenance to the utilities' physical plant within the Right-Of-Way. However, if upgrades or improvements are made due to the repair and/or maintenance, then the proper fee (check or money order) made out to the "City of Daphne" will be required as described and calculated in an Appendix B of the most current City of Daphne Right-of-Way Ordinance.

30. 3. 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.

32. 4. 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.

34. 5. 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.

36. 6. All work in the Right-Of-Way shall be permanently stabilized with vegetation, preferably solid sod. Permittee's that leave repair/maintenance sites within the City's Right-Of-Way unstabilized shall be charged a minimum of $60.00 (10 sq yds at $6.00) as allowed by the most current City of Daphne Right-of-Way Ordinance.

38. Are you a sub-contractor for the Utility?*

    1. Yes
    2. No
39. If "Yes," what Utility?
41. Contractor's City of Daphne Business License #?*
43. Date/Time Emergency Work Commenced?*
    Date/Time Emergency Work Commenced?
44. Date/Time Emergency Work Completed?*
    Date/Time Emergency Work Completed?
46. Applicant's Digital Signature*
50. For Internal Use Only
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57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit Submit and Print

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