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2. Right-of-Way Permit Application and Locate Request
4. Regardless of whether you are needing locates only and are not working in the ROW, please complete this application so we will have your correct contact information.
6. Is this for a Development Project?

   Development is defined as private party proposing to construct public facilities (i.e. Potable Water, Sewer, Drainage, Roadway, Sidewalk). Does not include franchise utility improvements (i.e. Electric, Phone, Communication, Gas).

   1. Yes
   2. No
8. Development Project Name:
10. Public Service Provider
12. Please select:

    1. AT&T
    2. Atmos Energy (gas)
    3. Bethesda WSC
    4. Charter
    5. Johnson Co. Rural SUD

    1. Pathway
    2. TXU Electric
    3. UCS
    4. Other
14. If other, name of company:
16. Contractor Information
18. Applicant Name:
19. Company:
21. Mailing Address
23. City
24. State
25. Zip
27. Contact Person (if different from applicant):
28. Email Address:
30. Phone:
31. Cell:
32. Fax:
34. Project Information
36. Please provide a description of where the work will take place:
38. The contractor is required to submit a map or drawing detailing the location and type of work to be performed.*
40. Estimated Start Date:
    Estimated Start Date:
41. Estimated Completion Date:
    Estimated Completion Date:
43. Additional Information
45. Is a utility structure included?

    1. Yes

    1. No
46. If yes, please obtain a Structure Permit through the Inspection Department. 817-426-9633
48. Is lane closure required for proposed work?

    1. Yes

    1. No
49. If yes, contractor must submit a site specific traffic control plan with this application.
51. Please upload site specific traffic control plan:
53. Is a video or photographs included?

    1. Yes

    1. No
54. If no, the contractor must sign a Video/Photograph Waiver Agreement.
56. Contractor must call Jason Smith, Right-of-Way Inspector at 417-846-5650 at least 48 hours prior to beginning construction.
58. Special Conditions and/or Restrictions
60. Through the applicant acting as an agent, the public service provider shall perform all work in public right-of-way/public easements in accordance with City ordinances, specifications and standards as they apply to such work. No change shall be made to the plans under this permit without prior written approval from the Public Works Department.
62. Street cuts are not permitted. Contractor is liable for any damages to public infrastructures including sidewalks and ramps. Contractor must restore and replace any amenities (private or public) to as good or better condition than before construction. This includes but not limited to grass, driveways, fences, etc.
64. For internal use only
66. Approval:
67. Date of approval:
68. Permit #:
Leave This Blank:


70. 1. Receive an email copy of this form.
71. Email address

    This field is not part of the form submission.

72. Submit

* indicates a required field