APPLICATION FOR SIDEWALK INSTALLATION PERMIT

VILLAGE OF SPENCERVILLE

Date:_________________________

This form must be completed thoroughly and submitted to the Village Administrator at least fourteen (14) days prior to any construction taking place. No work shall begin until the Administrator has authorized this permit in writing.

Please fill in the following information and provide a detailed sketch of the work to be done:

1. Location of work   ________________________________________________

2. Description of work          ___________________________________________

3. Name of contractor or person doing work         __________________________

4. Date work is to begin and be completed           __________________________

5. Signature of property owner        _____________________________________

6. Telephone number            ___________________________________________

Provide a detailed sketch below; attach additional pages if necessary:

Authorized by:____________________________         Date:_________________

Permit Number:  ___________________________________

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