*Permit valid only during this period unless extended by Department.
The applicant named above shall fully complete and sign this form. Unless otherwise approved by the Bloomington Parks and Recreation Department, this application must be submitted at least 7 days prior to date work is to begin. The permit is not valid until signed by the Department. Please keep a copy of the signed permit for your records. The applicant or his agent is solely responsible for providing notice as required by state law to all underground utilities before commencing an excavation.
By signing below I affirm that the information provided above is true. I agree to abide by any and all conditions imposed below. I agreeto indemnify and hold harmless the City, the Board, and the officers, agents and employees of the City and the Board from any and all claims, demands, damages, costs, expenses or other liability arising out of the reckless or negligent act or omission or any willful misconduct on the partof the applicant or any contractors retained by the applicant for work under this permit. If I disagree with the denial of this permit or any conditions imposed, I may appeal in writing within 10 days to the Board of Park Commissioners.