Application for Access Into County Right of Way

Date:
Application is hereby made by: (Name of Contractor):
Address:
Phone:
And (Name of Owner):
Address:
Phone:
for the purpose of laying pipe:
size, conduit,curbs,shoulders, sidewalk or other, etc:
to excavate trench:	ft. wide ft. long ft. deep
on County Road:
County Road Number:
Municipality:
Lot No.:
Block No.:
NEW JERSEY ONE CALL (1-800-272-1000) Reference Number :

Describe any special conditions:

-Permit charge of $100.00 for Residential
work must be submitted with this application.
-Permit charge of $200.00 for Commercial
work must be submitted with this application.
-Inspection charge of $50.00 minimum per
each inspection.
-Escrow amounts shall be calculated in accordance with the resolution.