DUBUQUE COUNTY UTILITY PERMIT
PERMIT NO: ___
ROAD:___
DATE: ___
TO THE BOARD OF SUPERVISORS OF DUBUQUE COUNTY, IOWA:
The (company name)_____, incorporated under the laws of the State of ___, with its principal place of business at (mailing address)_____(city)_____, (state)_____, (zip)____ does hereby make application requesting permission for underground construction of ___.
Plat of proposed underground construction showing location and pertinent information shall be attached to this application.
The proposed construction will be located miles from ,
(E,W,N,S) (intersection, place, town, etc.)
Township:_____, Section:___ on (County road name)
More specifically described as follows: ___
Agreements. The applicant agrees that the following stipulations shall govern under this permit:
Permits from the County are required before any utility installation can begin.
All permit holders must submit a Certificate of Liability Insurance with Dubuque County named an additional insured party.
All permit holders must submit a Hold Harmless Agreement. The owner of the utility facility shall indemnify and hold harmless Dubuque County, its agencies and employees, from any and all causes of action, suits at law or in equity, for losses, damages, claims or demands, and from any and all liability and expense of whatsoever nature, arising out of or in connection with the owner's use or occupancy of the public highway.
All costs for the location, construction and maintenance of the utility installation covered by this application shall be the responsibility of the permit holder.
The permit holder will file a plat showing the location, horizontally and vertically, of the proposed utility line, and that said plat is hereby made a part of this agreement; and that the description of the proposed installation shall include type, height and spacing of poles, maximum voltage, length of cross arms, minimum clearance and number of wires; type, size and capacity of underground cables, conduits, tile lines and pipe lines and maximum working pressures for pipe lines carry flammable products.
The installation shall meet the requirements of local municipal, county, state, and federal laws, franchise rules and regulations, regulations and directives of the Iowa State Commerce Commission; Utilities Division, the Department of Natural Resources, all rules and regulations of Dubuque County and any other laws or regulations applicable.
Utility poles placed within the county rights-of-way must be placed along the right-of-way line. Poles shall be located to provide sight distance at intersections.
Any open trenches in the roadway embankment must be completely backfilled with Class A crushed rock in no more than six inch lifts, and each lift thoroughly compacted before the next lift is placed.
1 of 4