RABUN COUNTY PUBLIC ROAD CUTS APPLICATION

Date of Application

Requested by

(Supervisor/Contractor/Individual)

Company or individual making request _____

Road name where work is to be done

Phone number of individual to be contracted regarding work ____

Date & time Supervisor/Contractor/Individual can meet on site with the road superintendent regarding the approval or disapproval of this application _________________________________________________________________

Specific work being done

Date work will begin

Date work will be completed

BY SIGNING BELOW I AM STATING THAT I HAVE RECEIVED, READ, AND UNDERSTAND THE ATTACHED ORDINANCE, SKETCHES, AND CHECKLIST.

Applicant’s Signature

Approved by

Application fee of $50.00 paid by

Cash Check Other

All soil erosion measures and any other permits are sole responsibility of applicant. After work is completed, it must be inspected by designee of Commissioner’s Office to be released.

Final inspection by Date