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Road Right-of-Way Permit

Fill in the application below, print it, sign it, and submit it with the fee to the Jersey Township offices.

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Jersey Township
1481 Mink Street SW, Pataskala, OH 43062
(740) 927-0331 Office · (614) 374-6975 Roads
www.jerseytownship.us

Jersey Township Road Right-of-Way Guidelines

Pursuant to Jersey Township Board of Trustees Resolution #26-01-05-____, any person, before making any excavation on a Jersey Township Road or work in a road right-of-way, must first obtain a permit from Jersey Township. This does not apply to the roadways in Jersey Township that are under the jurisdiction of the Licking County Engineer’s office or the Ohio Department of Transportation.

Per O.R.C. [§5571.16] - Applications for permits under this section shall be made to the Township Fiscal Officer upon forms to be furnished by the Board. Applications, including, but not limited to, a single application for an excavation project to install six or more poles for the purpose of providing electric or telecommunications service or to install a pole associated with underground electric or telecommunications service, shall be accompanied by a fee of up to fifty dollars per application, which fee shall be returned to the applicant if the application is denied. Except as otherwise provided in this section, no application or fee shall be required for an excavation project to install five or fewer poles for the purpose of providing electric or telecommunications service, but the person making that excavation shall provide verifiable notice of the excavation to the Township Fiscal Officer at least three (3) business days prior to the date of the excavation.

Requirements:

  1. A fee of fifty dollars ($50.00) shall be paid upon submission of each application.
  2. A separate application is required for each excavation to be made.
  3. The following shall be submitted with the application. Submission of the items listed, by way of example and not of limitation, shall be a condition of granting the permit.
    1. Plans indicating the location, size, type, and duration of the excavation contemplated.
    2. The applicant shall specify methods of excavation, refilling, and resurfacing to be followed that meet or exceed Ohio Department of Transportation Construction and Material Specifications.
  4. The applicant agrees to provide and place such warning devices as the Board of Trustees considers necessary to protect travelers on the road and to ensure their safety.
  5. The applicant must contact Ohio Utilities Protection Services (OUPS) prior to excavation.
  6. Licking County maintains four policies that Jersey Township also requires.
    1. Pavement cuts are not permitted.
    2. The “Frost Period” shall run between December 1 and April 15. During this period there will be no work permitted in the road right-of-way.
    3. Depth of pipeline: a minimum of 36 inches below ditch or channel and a minimum of 36 inches around cross culverts and bridges.
    4. Depth of buried service cable: A minimum of 36 inches below pavement, below ditch or channel, and around cross culverts and bridges.
  7. The applicant must contact the Jersey Township Road Department a minimum of twenty-four (24) hours in advance of starting work covered by this permit.
  8. Jersey Township requires 10 working days to process this application.
  9. Following the making of excavation, Jersey Township reserves the right to inspect any excavation made to ensure compliance with plans and specifications submitted with this application and/or requirements made by Jersey Township as a condition of approval.

Road Right-of-Way Permit

Permit #:

Worksite Information

Type of Work:

Note: The property owner is responsible for final grade and seed on yard tile installations.

  1. Fee: $50.00
  2. A performance bond or certified check made payable to the Jersey Township Trustees in the amount of $2,500.00 is required before any work begins. Proof of liability insurance with Jersey Township named as Additionally Insured for any work performed over $2,500.00 in project cost.
  3. Plans and detailed specifications.
  4. Statement of Indemnity.

By signing below, I acknowledge that I have fully read, understand, and agree to all terms of this application.

Signature & Title
Date

(For Township Use)

Permit Fee Paid: cash □ check □ check # ________ Date Received: ________

Bond or Check Received: # ________

Plans and Detailed Specifications Received: □

Statement of Indemnity Received: □

Plan Review and Approval/Denial:

Road Superintendent
Date
Administrator
Date
Trustee
Date

Approved: □   Approved with Conditions: □

Denied: □   Reason for denial: ______________________________________

Final Inspection: Approved □ Denied □ Date: ________

Road Superintendent
Date

Comments:

Statement of Indemnity

To the fullest extent permitted by law, I shall indemnify and save and hold free and harmless the Jersey Township Board of Trustees and Jersey Township, its officers, employees, agents, servants, and volunteers from any and all actions, claims, demands, judgments, damages, losses, and expenses, whether direct or indirect, including but not limited to attorney’s fees, arising from any accident or occurrence related in any manner to the excavation(s) proposed in this Application. I shall undertake to defend, at my own expense, any and all actions, claims, or demands brought against the Jersey Township Board of Trustees and Jersey Township, its officers, employees, agents, servants, and volunteers by reason of or related in any manner to the excavation(s) proposed in this Application, and to pay, settle, compromise and procure the discharge of any and all judgments, damages, losses and expenses, including but not limited to attorney’s fees.

I, and anyone I employ by reason of or related in any manner to the excavation(s) proposed in this Application, am an/are independent contractor(s) and as such shall not at any time be considered an officer, employee, agent, servant, or volunteer of Jersey Township.

I understand and I agree to carry such bodily injury and property damage liability insurance as will protect myself, anyone I employ, and Jersey Township against any and all claims for personal injury, including death, or property damage, which may arise from or be related in any manner to the excavation(s) proposed in this Application.

By signing below, I indicate that I have fully read, understand, and agree to all terms of the above Statement of Indemnity.

Applicant’s Signature & Title
Date
Permit Number
Original PDF

Information typed on this page stays on your device. Nothing is sent to the township. Print, sign, and bring or mail the form with the fee, bond or certified check, plans, and specifications.