Linear Utility/Sewer and Water Line/Excavation Permit Application

2. Project Description*

4. Contact email*

6. Name of Applicant*

8. Address*

10. City*

11. State*

12. Zip Code*

14. Contact Person*

15. Office Phone*

16. Cell Phone*

18. Name of Contractor Performing Work*

20. Address*

22. City*

23. State*

24. Zip Code*

26. Contact Person*

27. Office Phone*

28. Cell Phone*

30. Applicant is responsible for all locations and Gopher State One Calls (including registration of new utility). Please describe and check all that apply. Attach one scale drawing of the project area. The drawing will show all existing and proposed right-of-way, curb, sidealk, trails, above and below ground facilities or appurtenances, and poles.<br> <br> Excavation Contractor must meet all City and MPCA Environmental and Sediment Control ordinances/policies at all times. Failure to do so may result in fines or revocation of permit.

    Applicant is responsible for all locations and Gopher State One Calls (including registration of new utility). Please describe and check all that apply. Attach one scale drawing of the project area. The drawing will show all existing and proposed right-of-way, curb, sidealk, trails, above and below ground facilities or appurtenances, and poles.
    
    Excavation Contractor must meet all City and MPCA Environmental and Sediment Control ordinances/policies at all times. Failure to do so may result in fines or revocation of permit.

32. Scale drawing*

34. Nature of work (check all that apply)*

    1. Cable TV
    2. Sewer
    3. Repair
    4. Other

    1. Electric
    2. Water
    3. Abandon

    1. Gas
    2. New
    3. Underground

    1. Telecommunications
    2. Replace
    3. Aerial

    If other, please describe below

36. Description of other (nature of work)

38. Type of Surface to be Disturbed*

    1. Gravel
    2. Easement

    1. Concrete
    2. Bituminous

    1. Trail
    2. Boulevard

    1. Sidewalk
    2. Other (signs, tress, etc)

    If other, please describe below

40. Description of other (type of surface to be disturbed)

42. Location (address or cross street)*

44. Size and Type of pipe, conduit, or cable

46. Voltage or Pressure

47. Length

48. Depth from surface

50. Distance from curb or centerline

51. Clearance on pole

53. Method of Installation*

    1. Trench
    2. Pneuma Gopher

    1. Plow
    2. Hand Dig

    1. Directional Bore
    2. Other

    1. Backhoe

    If other, please describe below

55. Description of other (method of installation)

57. Estimated Start Date*

58. Estimated Ending Date

60. Will detouring of traffic be necessary? (Traffic control must comply with MMUTCD)*

    1. Yes

    1. No

62. Restoration Planned (All restoration must be in-kind)*

    1. Bituminous Paving
    2. Hand Formed Curb or Sidewalk w/Forms

    1. Motorized Tamper (Compaction)
    2. Sodding w/4" Topsoil

    1. Machine Formed Curb
    2. Seeding w/4" Topsoil

64. Permits are issued subject to all the terms, conditions and requirements of Section 800 of the Brainerd City Code. By executing this application and accepting the permit, the Applicant agrees to fully comply with all terms, conditions and requirements of Section 800 of the Brainerd City Code.

    Permits are issued subject to all the terms, conditions and requirements of Section 800 of the Brainerd City Code. By executing this application and accepting the permit, the Applicant agrees to fully comply with all terms, conditions and requirements of Section 800 of the Brainerd City Code.

66. *Signature*

    *Actual signature (not electronic) will be required on the City's permit document

67. Date*

69. Once your permit has been approved by the City, you will receive an email with your permit number, which is required for online payments. Payment can then be made at the City's webstore, in person at City Hall, or with a check through the mail.

    Once your permit has been approved by the City, you will receive an email with your permit number, which is required for online payments. Payment can then be made at the City's webstore, in person at City Hall, or with a check through the mail.

73. Fees

    Linear Utility Projects - $45.00 each separate excavation (i.e. handholes, trenches) and $.035 cents more per foot for boring/trenching/Pneuma Gopher lengths in excess of 100 feet. <br> <br> Residential Excavation - $45.00 each separate excavation (properties serving 4 or less housing units<br> <br> Commercial Excavation - $70.00 each separate excavation (commercial properties or residential properties serving more than 4 housing units)<br> <br> Sewer/Water Line - Residential - $45.00 each separate excavation + $40.00 each connection (properties serving 4 or less housing units)<br> <br> Sewer/Water Line - Commercial - $70.00 each separate excavation + $70.00 each connection (commercial properties or residential properties serving more than 4 housing units)

    Linear Utility Projects - $45.00 each separate excavation (i.e. handholes, trenches) and $.035 cents more per foot for boring/trenching/Pneuma Gopher lengths in excess of 100 feet.
    
    Residential Excavation - $45.00 each separate excavation (properties serving 4 or less housing units
    
    Commercial Excavation - $70.00 each separate excavation (commercial properties or residential properties serving more than 4 housing units)
    
    Sewer/Water Line - Residential - $45.00 each separate excavation + $40.00 each connection (properties serving 4 or less housing units)
    
    Sewer/Water Line - Commercial - $70.00 each separate excavation + $70.00 each connection (commercial properties or residential properties serving more than 4 housing units)

77. Date Received

78. Permit Fee

79. Permit Number

81. Approved By

82. Approved Date

84. Existing Street Age

    1. 0-5 years

    1. 5 years to 5 year CIP

    1. 5 year CIP

86. Conditions of Approval

88. All work including restoration was completed on (date) and is ready for final inspection

89. Signature

    Sign when all work is completed

91. Payment

    City of Brainerd Webstore

    The following link can be used for making payments online.

Leave This Blank:


92. 1. Receive an email copy of this form.
93. Email address

    This field is not part of the form submission.

94. Submit

* indicates a required field