Saline County Road Department

Saline County Courthouse

200 N. Main, Room 116

Benton, AR  72015

Lee McCampbell

501-317-6009 OR 501-303-5658

PERMIT FOR WORK IN COUNTY ROAD EASEMENT

Date Requested:  ________________________________________________________________________

Requested by:  __________________________________________________________________________

Work to be done by:  _____________________________________________________________________

Contact Person:  ________________________________________________________________________

Phone:  _______________________________________________________________________________

Cell:  _________________________________________________________________________________

Address:  ______________________________________________________________________________

Location of job:  _________________________________________________________________________

Proposed work:  ________________________________________________________________________

Approximate work start date:  ______________________________________________________________

Approximate completion date:  ______________________________________________________________

Other information or job number:  ___________________________________________________________

Approved:  _____________________________________________________________________________

Lee McCampbell

Saline County Planning Board

Code Enforcement Officer

The undersigned agrees, in accordance with ordinance number ______________ to repair any damage done to the county road or right-of-way during maintenance or installation of proposed facility.

NOTICE:  Written permission from the Saline County Judge is required before cutting a county road.  If written permission is granted, all repair and maintenance on said cut will be provided by grantee for one year after completion.

Signature:  __________________________________________________________

Permit Number:  ___________________