City of Lynchburg Public Right-of-Way

Application for Permit to Use

Under City Code sections 25-212 and 35-12 work in City Right-of-Way requires a permit from the Engineering Department and payment of a fee set by the City Manager. Violation of this Code section is a Class IV misdemeanor.

Today's Date

Business/Company Name (if applicable)

Business/Work Phone

Mobile/Alternate Phone

Worksite Location Street Address

Description of proposed use of Right-of-Way:

Does this use include excavation?

Yes

Name of Project Manager if different than above.

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Upload work schedule and MOT plan if available.

Click Here to Upload