Road Opening Request Form

This application is required to break and open any street or road, or perform any work within Silverdale Borough Right-of-Ways.

Please contact the Borough office with any questions.

Step 1 of 4

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1. Applicant Information
Applicant/Utility Company Name*
Type of Utility*
- Electric
- Cable
- Water/Sewer
- Telephone
Applicant Address*
Street Address Address Line 2 City State ZIP Code
Contact Person*
First Last
Email*
Phone*

2. Contractor Company Information
Please provide information about your contractor company, if applicable.
Is the work being done by a contractor?*
- Yes
- No
Select Yes if contracting company is different than the Applicant company.
Contractor Company Name
(If different from applicant)
Contractor's Contact Person
First Last
Contractor's Phone
Contractor's Address
Street Address Address Line 2 City State ZIP Code

(if different from applicant)

3. Work Description
Please enter details about the planned work.
Work Location*
Please provide street location. Example: (street name), between (cross road 1 and cross road 2).
Work Start Date*
Work Completion Date*
General Description of Work*
Please describe any other existing signs on the property.

4. Agreement, Supporting Documents & Verification
ROAD ACCUPANCY PERMIT FEE: $250.00

ESCROW FEE: $1500.00

NOTE: Estimate for the escrow includes asphalt base (trench) and overlay plus incidentals (seam seal, traffic control, etc.) to guarantee cartway/right-ow-way restoration where applicable. Escrow does not include trench excavation, backfill, or other costs related to utility construction.

Any work performed within the right-of-way of a Borough road requires submission of this form along with drawings showing the location and details of proposed work.

Any work performed on a Borough road over, under or within the limits of a limited access State highway requires a State permit from PennDOT.

The prescribed permit fee according to the adopted Fee Schedule Resolution in effect at the time of submission, along with the required escrow shall accompany the application and sketch.

** PLEASE NOTE THE ESTIMATE FOR THE ESCROW INCLUDES ASPHALT BASE (TRENCH) AND OVERLAY PLUS INCIDENTALS (SEAM SEAL, TRAFFIC CONTROL, ETC.) TO GUARANTEE CARTWAY, RIGHT-OF-WAY RESTORATION WHERE APPLICABLE.
Plan File Uploads*
Drop files here or
REQUIRED. All files must be less than 100MB in size.
We hereby make application for a Road Occupancy Permit and submit drawings showing location and details of work proposed within the Silverdale right-of-way. The Applicant agrees to completely restore unimproved surfaces to their preconstruction condition and restore improved surfaces.
Applicant Company Name - Agreement*
Authorized Applicant*
First Middle Last
Title*
By submitting this form, we certify all data herein is true and complete.
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Road Opening Request Form

Road Opening Request Form

Step 1 of 4

1. Applicant Information

2. Contractor Company Information

3. Work Description

4. Agreement, Supporting Documents & Verification

Community Links

PA State Government Links

Environmental Resources

Contact Silverdale Borough

Road Opening Request Form

Road Opening Request Form

Step 1 of 4

1. Applicant Information

2. Contractor Company Information

3. Work Description

4. Agreement, Supporting Documents & Verification

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Community Links

PA State Government Links

Environmental Resources

Contact Silverdale Borough