Date: _________________________
Applicant: _________________________________________
Address: __________________________________________
_________________________________________________
Telephone: ________________________________________
Contact Person: _________________________________ Telephone: _______________________
Location of Crossing: | |
| Road Name ___________________________________________________ |
| Property Owners _______________________________________________ |
Type of Crossing: Natural gas _______ Water _______ Electric _______Other________
Applicant
must notify PA One Call of project and supply Township with reference number.
Describe current road surface and method of crossing: (bore, open cut, etc.) __________________
_______________________________________________________________________________
_______________________________________________________________________________
Final road surface finished will match existing road surface and applicant will be responsible for correcting any and all surface for ___________year(s) from date of project completion.
All road crossings will require a temporary driveway access on both sides of the roadway. A diagram
must be included with this application showing the following:
- Width of driveway needed for access to actual work area.
- Proposed location of the driveways at the crossing.
- Materials/drain pipes to be used in the construction of the driveways.
The course grade, construction and drainage facilities.
Explain plan for restoration and seeding of the area upon cessation of its use:_________________
_______________________________________________________________________________
_______________________________________________________________________________
This application must be accompanied with a fee of $ _______, payable to Harford Township.
No construction of driveways at crossing work sites or actual crossings will be permitted until a Crossing
Permit application has been issued by Harford Township Supervisors or their designated representative.
Any work on Township Roads or right of ways must be performed in a manner that will not close the
roads to traffic. All emergency vehicles, school busses, mail delivery vehicles and municipal vehicles
must be allowed to pass through access at all times.
The company will provide dust control on the road being used for pipeline construction during the
spring, summer and fall.
The Township will only grant permits for crossing the roadway. Construction of, or running a pipeline
parallel to road within the road right of way is prohibited.
The completed crossing project must be inspected by a Township Official when the project is completed.
The Harford Township Supervisors will not be responsible for damages to private properties beyond the
Township Road Right of Ways. Actual Right of Ways may be 33 feet or 50 feet
Applicants will be required to obtain any and all approvals necessary prior to entering personal
properties. This Permit does not give Applicants permission or right to enter personal properties under
any circumstances.
Permit is valid for 12 months form date of issuance. Please notify the Township at 570-434-2401 at least
48 hours before start of construction.
HARFORD TOWNSHIP SUPERVISORS: | APPLICANT: |
__________________________________ | ______________________________________ |
__________________________________ | ______________________________________ |
__________________________________ | ______________________________________ |
(minimum two signatures required) | |
Date Received:______________________ | Application # _____________________ |
Permit Fee _________________________ | Check # _________________________ |
FINAL INSPECTION | |
Date: ________________________ | Permit issued _________ (yes) # _______ |
Approved by: ______________________________________________
Comments or re-inspection required: ______________________ (no)
______________________________________________________________________________
______________________________________________________________________________