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2. Name
3. Email Address
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
12. Fax Number
14. Contractor's Name
15. Contractor's Phone Number
17. Contractor's Address
19. City
20. State
21. Zip Code
23. Type of Permit*

    1. Driveway Approach
    2. Sidewalk
    3. Sidewalk in driveway limits
24. Proposed Surface

    1. Concrete
    2. Blacktop
25. Type of Work

    1. Construct
    2. Reconstruct
26. Type of Facility

    1. Residential
    2. Commercial
28. Amount of Work
29. Length
30. Width
31. Sq. Footage
33. Plans Attached

    1. Yes
    2. No
34. Image upload

36. Permit applications are $20.00 cash, check, or credit card and can be dropped off at Delhi Township Public Works Department 665 Neeb Rd.

    I hereby agree to all terms, conditions and restrictions written or printed below and to the Driveway Approach and Sidewalk Regulations of Delhi Township, Including precautions for the protection of the public and all utilities within the public-right-of-way and to any and all installations in and around said driveway approach or sidewalk. If work done under this permit involves or endangers belonging to others, I shall immediately notify the owner.

    This permit may at any time be revoked annulled by the Delhi Township Permit Office for non-performance and/or non compliance with any of the conditions, restrictions, and regulations.  Violations of non-compliance of said regulations are subject to penalties provided by Section 5589.10 and 5591.26 of the Ohio Revised Code.

    At all times during the progress of the work, adequate protection and passage shall be provided by the permit holder for the traveling public.

    Plans and/or application must be approved and permit secured before commencing work.  Delhi Township regulations require that you notify the Delhi Township Permit Department in writing or call 922-8609 (between 7:00 AM and 9:00 AM) forty eight (48) hours before starting construction. 

38. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
40. Electronic Signature
41. Date
    Date
45. PERMIT NO.
46. RECEIPT NO.
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48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field