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2. APPLICATION FOR STREET OPENING PERMIT
4. Proposed Construction Starting and Ending Dates
   Proposed Construction Starting and Ending Dates Start Date

   —

   Proposed Construction Starting and Ending Dates End Date
6. Contractor Name and Phone Number
8. Type of Property

   1. Residential Property

   1. Commercial Property
10. Type of Project

    1. Sewer Repair or Tap

    1. Water Service Repair or Tap

    1. Other (Provide Project Description and Site Plan Drawing Below)
12. Project Description (See above)
13. Site Plan Drawing (See above)
    A PDF file can be attached.
15. Applicant's Name and Mailing Address*
    NOTE: This is the name and address that will be used to refund street opening deposit.
17. E-Mail Address*
    Payment instructions for approved permits will be sent to this address.
19. Street Opening Permits Require a Deposit
    The deposit is equal to $1,030 per lane width disturbed. The deposit will be returned to the above listed applicant when the street is restored to City Standards and passes inspection by City Inspectors. Also at the time of application, a non-refundable $54 inspection fee is due.
21. By submitting this application, the applicant agrees:
    1) to be legally responsible for any and all consequences arising from said excavation; 2) to be responsible for traffic control and notify the City of Xenia's dispatch of all necessary lane closures and 3) to restore all disturbed areas of the City Right-of-Way to like or better conditions in accordance with the City of Xenia's Construction Standards.
23. ALL PERMIT HOLDERS ARE RESPONSIBLE FOR CONTACTING THE OHIO UTILITIES PROTECTION SERVICE PRIOR TO EXCAVATION
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field