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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. Type of Permit

    1. Opening
    2. Jacking
    3. Tunneling
20. Type of Pavement

    1. Asphalt
    2. Concrete
21. Type of Curb

    1. Concrete Rolled
    2. Concrete Vertical
    3. Asphalt
    4. None
23. Opening
25. Length
26. Width
27. Depth
29. Plans Attached

    1. Yes
    2. No
30. Purpose
32. Plans attached
33. Plans attached

35. I hereby agree to all terms, conditions and restrictions written or printed below and to the Pavement Opening Regulations of Delhi Township, including the 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 pavement openings.  If work done under this permit involves or endangers structures belonging to others, I shall immediately notify the owner.   

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

                    All pavement openings must be filled or plated if they are to be left unattended; however, longitudinal openings of major proportions may be left open when certain procedures are followed.  This exception does not apply to "RESTRICTED" roads where full width of pavement must be unencumbered for vehicular traffic from 7:00 to 9:00 A.M. and 4:00 to 6:00 P.M.

                    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 513-922-8609 (between 7:00 A.M. and 9:00 A.M.) forty eight (48) hours before starting construction.

37. 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.
39. Electronic Signature
40. Date
    Date
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42. 1. Receive an email copy of this form.
43. Email address

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44. Submit

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