Form Center

2. This is a Utility Permit application for all utility installations including telecommunications, cable TV, telephone, electric and/or drainage tile.
4. §115 RIGHT-OF-WAY AND UTILITY INSTALLATION PERMIT REQUIREMENTS

   Please click here to read the Waukee Utility Permit Requirements prior to completing this application.

   
   

   Call 515-978-7920 with questions.

6. Company Name*
7. Street Address*
9. City*
10. State*
11. Zip Code*
13. Contact Person*
14. Phone Number*
16. Email Address*
17. Bond Number*
19. Location of Utility Work*
21. Upload map, if available
22. Date(s) of Work*
24. In consideration of the conditional right to occupy the right-of-Way at the location specified above (if subsequently approved), we agree to the following:
    1) Any and all installations by company pursuant to the request/application referenced above shall be placed as not to interfere with the construction of any water pipes, drains or sewers, or the flow of water therefrom, or streets, sidewalks or other public infrastructure which have been or may hereafter be located by authority of the City, and further providing the same shall be placed in accordance with any regulation the City may from time to time adopt or amend regarding the placement of facilities or structures of utilities, and other right-of-way users facilities or structures, in the right-of-way.
    
    2) The company shall, upon 30 days’ notice by the City, cause any company utility lines/ infrastructure within the City right-of-way to be removed, relocated at the company’s sole expense. In the event that company fails to remove or relocate the same within the time period prescribed, the City is authorized to cause the same to be removed, and Company agrees that in the event the City removes the same pursuant to this provision, company shall indemnify and hold the City harmless from and all liability of any kind whatsoever occasioned by the City’s removal of said lines/equipment or infrastructure including but not limited to claims for loss of service, claims in any way related to damage or destruction of any company or customer equipment, lines or infrastructure related to company’s service or business, and any and all other liability or claims which may arise by virtue of said removal by City hereunder.
    
    3) The company acknowledges the City’s authority to manage and regulate the use of the City’s Rights of way by your company.
    
    4) The company agrees to comply with any and all ordinances, regulations or policies the City may from time to time adopt or amend.
    
    5) The company shall indemnify and save harmless the City from any and all claims, suits, losses, damages, costs or expenses, on account of injury or damage to any person or property, caused or occasioned in whole or in part, by the company’s activities, presence or occupancy in the City’s rights-of-way.
    
    6) The company and its contractor will place door hangers with contact information on the affected residents 48 hours prior to beginning any work in the right of way or public utility easements.
    
    7) The company and its contractors agree to remove locate flags immediately after completion of work in that area.
    
    8) The company and its contractors shall not park or store any equipment or vehicles on sidewalks or bike paths.
    
    9) The company and its contractors shall restore the Public Utility Easements and Right of Way to their previous condition immediately after construction in the area is completed. In developed areas sod will be required and must be watered by company until sod is established. In undeveloped areas hydro seeding is required immediately after construction in the area is completed.
26. Signature*

    1. I agree.

    Under Penalty of Perjury, I do hereby represent and warrant that I am an authorized representative of the company identified above and fully authorized to bind said company to the terms of this agreement. Said company seeks to install and utilize it's facilities in the City’s Rights of Way and, if approved by the City, in doing so it shall be bound by this agreement and the Federal, State and local laws and ordinances. The undersigned, having read the foregoing does hereby agree to the foregoing terms and conditions on behalf of company and agrees that company shall be bound by the same.
28. Name*
29. Title*
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field