Lehi City Right of Way Winter Encroachment Permit (December 1

Property Owner's Name*

First NameLast Name

Address of Work*

Applicant's Email*

example@example.com

Contractor's Name*

First NameLast Name

Contact Phone Number*

Area CodePhone Number

License Number

License Expiration Date*

Date

Project Start Date*

Date

Blue Stakes*

Number

Emergency Contact*

First NameLast Name

Emergency Phone*

Area CodePhone Number

NO ENCROACHMENT PERMITS ISSUED DECEMBER 1 – MARCH 3

Twenty four hours before work permitted here within commenced, the applicant shall notify Lehi City. Commencement of said work is
understood to indicate that the applicant will comply with all instructions and regulations of Lehi City Corporation with respect to performance of
said work, and that he will properly safeguard said work to prevent accident and shall hold Lehi City Corporation free and harmless from all
damages arising out of any and all operations performed under this permit (Please Contact Greg Allred, with the Water Department, 801-836-
1042 before digging for water utilities.) Work needs to commence within 10 days of permit approval, or you will be required to reapply.

Asphalt Patching of the Roadway Needs to be Completed within 5 Days

All work must be completed and inspected by Lehi City Street Inspector or his designee within 30 days of permit issuance. If an
inspector is requested for other than normal working hours, it will be billed to you at $50.00 per hour with a one hour minimum charge. If
additional time is required for asphalting, approval is needed by the Street Department. Please contact Rochelle Peterson 385-201-2429 for
extension.

If the applicant fails to comply with Lehi City Corporation regulations or instructions pertinent to this permit, an authorized representative of Lehi
City Corporation may verbally order the applicant to suspend the work until the violation is corrected. If the applicant fails or refuses to comply
promptly, the Lehi City Representative may issue a written order stopping all or any part of the work. When satisfactory corrective action is taken,
a start work order may be issued.

In the event applicant fails to properly perform necessary repair or replacement as required under this permit, applicant hereby surrenders all fees totaling on said permit to Lehi City Corporation without any further notice.

Initials*

I have read and agree to the above information

ROAD CLOSURE POLICY
In the event that a “Road Closure” is necessary, Lehi City requires that a “Road Closure Plan” be approved through the Public Works office
located at 2538 N. 300 W. Bldg. D at least 24 hours prior to work starting. The plan needs to show use of appropriate closure and detour signs, as
well as placement of proper road barriers. Roads will not be allowed to remain closed if no work is going on. Re-opening of roads on evenings
and week-ends may also be required. This will allow passage of emergency vehicles and local traffic.

Description of Work Being Done*

Asphalt, Concrete Removal and Repair

Permit Base Fee

$350.00

Sq. Ft. of Road Cut X < 5 years Foot for area

$0.50 Quantity

Sq. Ft. of Road Cut X > 5 years Foot for area 2

$0.25 Quantity

Bore Directional Fee

$200.00

Bore LF (Base Fee Plus)

$0.25 Quantity

Pothole (per core)

$25.00 Quantity

Road Closure Fee

$300.00

Road Closure Extension

$150.00

Total

$0.00

Address of Road Cut*

ALL REGULATIONS APPLY FROM LEHI CITY DESIGN STANDARDS AND PUBLIC IMPROVEMENT SPECIFICATIONS. THE CONTRACTOR IS RESPONSIBLE TO REPLACE ALL CONCRETE WITHIN FIFTEEN (15) WORKING DAYS

Contractor's Signature*

Date to be Completed*

Date

Please upload any relevant documents (maps, plans, etc.)

Browse Files

Franchise Agreement Encroachment Permit