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2. About Electronic Signatures

   By checking the "I agree" box for each signature, you agree and acknowledge that 
   1) your application will not be signed in the sense of a traditional paper document,
   2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 
   3) you may still be required to provide a traditional signature at a later date.

4. Type of Permit

   1. Excavation Permit

   1. Obstruction Permit
6. Applicant Name
7. GSOC Reg. #
9. Address
11. City
12. State
13. Zip Code
15. Phone Number
16. Fax Number
18. General Contractor
19. GSOC Reg. #
21. Work Phone Number
22. Cell Phone Number
24. Email Address
25. 24 Hour Phone
27. Location and Description of Work (Closest Street Address)
29. Attach Permit Map

    Please show location of proposed utility including reference to City street center line.

33. Facilities Information

    1. Cable
    2. Cooling
    3. Electric
    4. Fiber

    1. Gas
    2. Heating
    3. High Pressure

    1. Low Pressure
    2. Sewer
    3. Telecommunications

    1. Traffic
    2. Water
    3. Other / Explain below
35. Other Facility:
37. Purpose of Construction

    1. New

    1. Replacement

    1. Repair

    1. Other / Explain below
39. Other Purpose of Construction
41. Type of Construction

    1. Aerial
    2. Bore

    1. Chamber
    2. Hole

    1. Plow
    2. Trench

    1. Other / Explain below
43. Other Type of Construction
45. Construction Details
47. Length
48. Width:
49. Depth:
51. Row Being Used

    1. Driving Lane
    2. Parking Lane

    1. Sidewalk
    2. Boulevard

    1. Utility Easement
53. Type of Material

    1. Concrete
    2. Bituminous

    1. Gravel
    2. Sod

    1. Field Grass
    2. Trees

    1. Shrubs
55. Structures

    1. Curb & Gutter
    2. Other / Explain below

    1. Sidewalk

    1. Signals
57. Other Type of Structure
59. Shoulders

    1. Bituminous
    2. Other / Explain below

    1. Gravel

    1. Road Signs

    1. Culvert
61. Other Type of Shoulder:
63. Construction Schedule
65. Estimated Starting Date(s):
66. Estimated Ending Dates:
68. Submit Communication Plan for Project Scope

    Upload examples of communications that will be provided to property owners along with the dates in which they will receive them.

72. Signature

    1. I agree.
74. Electronic Signature
75. Date
    Date
79. Restoration Requirements

    1. Disturbed areas must be restored following the most current City of St. Anthony Village specification, see Chapter 2575 ESTABLISHING TURF AND CONTROLLING EROSION. The restoration requirements listed below are a summary of the requirements specified. The Contractor is responsible for following the specifications as outlined in the current City Specification:

    a. Minimum 6” of topsoil and blown compost seeding is required for turf areas.

    b. The seeding shall not be done until the Engineer has inspected the area and approved the subgrade preparation and topsoil materials.

    i. Seed mix shall be "Boulevard Mixture" as manufactured by Twin City Seed Company or approved equal.

    ii. Compost shall conform to these requirements above and beyond MnDOT‘s compost requirements as specified in MnDOT requirements for compost 3890.

    Review the current City Specification: LINK TO SPECIFICATION (PDF)

    2. Maintenance of restoration areas:

    a. This work shall consist of maintaining seeded areas to establish a “sod-like” turf until final acceptance of the project. Maintenance shall include, fertilizing, mowing (when greater than four inches (4"), weeding, and other operations such as rolling, re-grading and replanting areas as required to establish a smooth, acceptable "sod-like" turf free of eroded or bare areas. If directed by the Engineer, the Contractor shall slit seed all areas on which the original seed has failed to grow using the type of seed directed by the Engineer. Reseeded areas shall be watered, fertilized, and maintained as specified above until final acceptance of the project. A growing day shall be defined as any calendar day between May and November.

    b. Post-Emergent Fertilizer for turf development period shall have an analysis containing an equal balance of Nitrogen and Potassium similar to 20-10-20 or 18-8-18. Approximately twenty-one (21) days after germination, The Contractor shall make four (4) additional applications of fertilizer containing a balance of Nitrogen and Potassium i.e. 20-10-20 or 18-8-18. Quantity of application shall be so calculated that the actual Nitrogen rate shall be one-half-pound (½ lb.) per one thousand (1,000) square feet. The application shall be made at two (2) week intervals, unless determined otherwise by the Engineer. At the beginning of the first full growing season after seeding has occurred, the Contractor shall make one (1) additional application of specified fertilizer at an application rate of one (1) pound per thousand (1,000) square feet. The fertilization shall be slow release. The Contractor shall notify the Engineer immediately prior to fertilization application.

    c. Frequent mowing of the grass will be critical to turf development. Proper mowing will contain early growth of ryegrass, allowing the slower germinating bluegrass to establish. The Contractor shall make weekly inspections of the turf growth to ensure that proper mowing is being accomplished. Frequent mowing of weeds shall be accomplished to prevent weeds from going to seed.

    d. Weeds or any other undesirable vegetation appearing shall be sprayed with an approved weed killer, and after killing, weeds shall be raked and removed from the area. Care shall be taken in the seeded area that grass is well established before spraying.

    e. Turf areas becoming gullied or damaged, including damage due to vandalism or neglect shall be repaired to re-establish condition of soil grade prior to seeding and shall then be reseeded as originally specified, at no additional cost to the City.

81. Signature

    1. I agree.
83. Electronic Signature
84. Date:
    Date:
88. Authorization of Permit (not valid unless bearing signature)

    In consideration of his/their agreement to comply in all respects with regulations of the Director of Public Works covering such operations, permission is hereby granted for the work to be done as described in the above application, said work to be done in accordance with special precautions required as hereby stated.

    This permit is conditioned upon replacement or restoration of the right-of-way to its original or to a satisfactory condition. I understand that a $2,000 minimum escrow (for up to 10 lots) Plus $20 escrow per additional lot, is required on all right of way permits, it may be adjusted upwards due to the scope of the project. All applications will be reviewed by the Public Works Director. 

    It is further understood that this permit is issued subject to the approval of the City and any other authorities having joint supervision over said street or highway and subject to the applicant’s compliance with the rules and regulations of any other affected governmental agencies. The date when work is completed must be reported to the Public Works Director.

    1. I agree.
90. Electronic Signature
91. Date:
    Date:
95. Rules and Regulations

    1.Except as otherwise permitted, utility construction and relocation on City right-of-way shall not be commenced until an application for a permit has been made and such permit granted. The permit map shall show the location of the proposed utility with reference to City street center line. A copy of the map shall be provided for each copy of such permit.

    2.Utility Owner shall be responsible for all communication and coordination with property owners. Notice must be given to property owners prior to the commencement of work.

    3.Utility Owner must submit a communications plan along with this permit including examples of communications that will be given to property owners along with the dates in which they will receive them.

    4.The Right-of-Way Permit Application form is to be used for excavations and/or obstructions in the right-of-way. This form upon receipt and satisfaction will then be converted to the permit.

    5.Restoration to be performed within 7 days from date of initial disturbance and established no later then 45 days for initial disturbance. Established defined as equal to or better condition than preconstruction. The CONTRACTOR will be subject to a daily charge for failure to complete restoration required. A $100.00 monetary deduction per calendar day will be deducted from any financial securities, until all work is completed to the satisfaction of the ENGINEER. No extension of time will be granted for delays caused by weather. If the Contractor fails to complete restoration to the satisfaction of the engineer requiring the City of St. Anthony to complete restoration repairs, the Contractor will be charged $2500 per repair.

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97. 1. Receive an email copy of this form.
98. Email address

    This field is not part of the form submission.

99. Submit

* indicates a required field