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t <br /> APPLICATION FOR OURAY COUNTY <br /> RIGHT-OF-WAY PERMIT <br /> The Right-of-Way Permit is for construction in or improvement to Ouray County rights-of-way. A permit is <br /> required to construct driveways, install telephone, electric, gas, sewer, water and other utility wires, pipelines, or <br /> the like, along, across, upon and under any road right-of-way which is owned or controlled by Ouray County. <br /> Permittee Contractor <br /> Name Name <br /> Company Company <br /> Address ;.,,r.,, -__-- -----_— Address <br /> City State Lip City State Zip <br /> Business Phone Business Phone <br /> Fax No. Fax No. <br /> Email Email <br /> Insurance Carrier Limits: <br /> Location/Description of Construction: <br /> CR at the following locations: , ` ; r e s;t. <br /> Address 4936 COUNTY ROAD : (-1; Subdivision Legal Desc. <br /> OURAY COLORADO 81421 <br /> HOW MANY FEET ARE YOU DISTURBING IN FHF: RIGHT-OF-WAY:-OF-WAY: ,If fl'sl rbanc r'i�ifir {: <br /> PLANS REQUIRED WITH APPI_l(':1,TION <br /> Type of Work: <br /> TV Cable Main Service Phone Main Service <br /> Gas Main Service i Water Main Service <br /> I Electric Main Service Set Pole I Sewer Main Service <br /> L Culvert inch by foot long corrugated pipe (0.16 gauge)with annular ends. <br /> 6"cover– /4"compacted road base. <br /> Vi Other <br /> I Cut Pavement(Repair must be completed in 15 days) <br /> 0 Include sketch showing excavation(s) with dashed line in relation to road, house and driveway <br /> Construction Schedule and Submittal Questions—All permit holders must request inspection 24 <br /> hours in advanceadof work commencing. Please call 970.626.5391 for inspection request. <br /> Planned Start Date 5:41, ,, [cam 2029 Daily Work Hours <br /> Planned Finish Date'tu f� 2,.ci L5L Weekend Work Hours <br /> Does project disturb more than acre? Yes No <br /> If yes, a Revegetation and Weed Control Plan needs to be submitted with application <br /> READ CAREFULLY <br /> Job must be finished and right-of-way restored to its original condition by expiration date. Failure to do so <br /> is a violation of state and local regulations and new permits may not be issued until the job is complete. <br /> Permit extensions may be granted by calling the road inspector. <br /> Applicant shall be responsible for confirming all utility locations within public rights-of-way prior to any <br /> excavation. Call UNCC: 1.800.922.1987. <br /> Work in the right-of-way is only allowed between ,00r4f and :00 Fie , <br /> weather permitting. A minimum of three working days is required to process this application. <br />