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2. 
4. A permit is required if you are working in the City right of way for any reason. There is a $20 fee for right of way permits (no charge for sidewalk permits). Depending on the type of project, additional fees may apply (see below). All right of way applications will be reviewed prior to permit issuance. Work may not begin until approval is given and permit is issued. Please allow up to 30 days review time.
6. Project address:*
7. City lot # (if applicable):
9. Parcel number (no dashes):
10. Subdivision (if applicable):
12. Type of project (check all that apply):*

    1. Sanitary (capacity fee - $1,800; and/or possible deferred assessment fees)
    2. Water (meter fee - $300 City/$350 Township; capacity fee - $450 City/$510 Township; tap fee - $500 (if applicable); and/or possible deferred assessment fees)
    3. Storm
    4. Drive approach
    5. Sidewalk (no charge for permit)
    6. Pavement (roadway)
    7. Gas line
    8. Misc. right of way excavation (i.e. drive culvert, ditch enclosure) - describe below
    9. Demo - describe what utilities (i.e. sanitary, water, storm) are affected in description of work below
    10. Other (describe below)
14. Location of excavation (check all that apply):*

    1. Utility strip (i.e. devil strip, tree lawn)
    2. Sidewalk
    3. Drive approach
    4. Pavement (roadway)
    5. Other location outside of right of way
    6. City easement
16. Detailed description of work:*
18. Please attach a detailed plan/drawing of the proposed scope of work (the contractor is responsible for preparing this plan). Plans should be to scale and include dimensions, property lines, and underground utilities including sanitary, water and storm mains. If needed, the Engineering Department can supply an aerial view GIS map that can be used to prepare your plan. If you are unable to attach a plan to this form, please mail or drop off at the City of Wadsworth, Engineering Dept., 120 Maple St., Wadsworth, OH 44281.
20. File upload #1
22. File upload #2
24. Lane closure required:

    1. Yes
    2. No
26. If yes, attach a site specific traffic control plan below. If no, please be advised that during plan review, the reviewing engineer may decide that one is required.
30. PARCEL OWNER INFORMATION
32. Name:
34. Mailing address:
36. City
37. State
38. Zip Code
40. Phone:
41. Email:
43. CONTRACTOR/AGENT (if applicable)
45. Contact name:
46. Company:
48. Mailing address:
50. City:
51. State:
52. Zip code:
54. Phone:
55. Email:
57. PROFESSIONAL ENGINEER/SURVEYOR (if applicable) - must be licensed in Ohio
59. Contact name:
60. License #:
62. Company:
64. Mailing address:
66. City:
67. State:
68. Zip code:
70. Phone:
71. Email:
75. Excavation to begin:
    Excavation to begin:
76. Excavation to be completed by:
    Excavation to be completed by:
78. Damage to underground utilities resulting from this excavation shall be the responsibility of the contractor performing the excavation. Before starting any excavation the Contractor MUST contact the Ohio Utilities Protection Service (OUPS) at 8-1-1 or 1-800-362-2764, at least 48 hours but no more than 10 working days before beginning ANY digging project.
80. For Engineering Department permits:
82. 1. Failure to obtain inspections during construction may result in penalties and/or removal and reconstruction of improvements.
84. 2. Work shall not proceed until the inspector has approved the various stages of construction.
86. 3. Required inspections can be arranged by calling (330) 335-2751 or by visiting the Engineering web page at wadsworthcity.com. Engineering inspections must be requested by 2:00 p.m. one business day before the inspection is needed.
90. Applicant's statement:
92. 1. I hereby certify that the owner of record authorizes the proposed work and this application, and I am acting as the agent on their behalf.
94. 2. I agree to conform to all applicable laws of the City of Wadsworth, all applicable codes and provisions stated in this application.
96. 3. I hereby certify that all land clearing, construction or development involving the movement of earth shall be in conformance with standard erosion, runoff and sediment control practices to prevent soils from being deposited onto adjacent properties, rights-of-way, public storm drainage systems, wetlands and/or watercourses.
98. 4. I agree to obtain the required inspections and that no part of the structure/improvements will be used or put into service until after obtaining the final inspections and substantial completion has been approved.
100. 5. I agree that authorized inspectors shall have the authority to enter areas covered by such permit, at any reasonable hour, to enforce the provisions of the code.
102. 6. I agree to comply with the above conditions, specifications and regulations of the City of Wadsworth governing this application. I understand that failure to comply may be cause for revocation of this application and issuance of a stop work order.
104. Digital signature of applicant:*

     Payment can be made by mailing or dropping off a check to City of Wadsworth, Engineering Dept., 120 Maple St., Wadsworth, OH 44281 or by calling (330) 335-2751 with a credit card number. Permits will not be issued until paid in full. All applications will be reviewed prior to permit issuance.

105. Date:*
     Date:
Leave This Blank:


106. 1. Receive an email copy of this form.
107. Email address

     This field is not part of the form submission.

108. Submit Submit and Print

* indicates a required field