EmailMeForm
Application must be made by the Landowner
Property Owner: Your Name
*
Mailing Address
*
City
*
Zip Code
*
Email
Daytime Phone
*
Cell Phone
*
WORK TO BE PERFORMED WITHIN RIGHT-OF-WAY
Location where work is to be performed:
Description of work to be performed on property recorded in your name?
Yes
No
Type of Work
Residential Drive
Field Drive
Commercial Drive
Temp Drive*
Ditch Enclosure
Field Drainage
Earth Grading
Tree Trim/Removal
Boring
Other
* See Supplemental Permit Requirements
Detailed Description
(as needed, add attachment if necessary)
File Upload
jpeg, jpg, tiff and pdf
Work will commence on or about
MM
/
DD
/
YYYY
Will require # of days to complete
enter # of days
LANDOWNER PERMIT REQUIREMENTS
I agree to comply with all conditions, restrictions, and regulations of the Fairfield County Engineer. If compliance is not met in the opinion of the Fairfield County Engineer, it is understood that the County Engineer reserves the right to stop work being performed and restore the right-of-way to an acceptable condition at the expense of the applicant.
*
YES
PLEASE ENTER FULL NAME:
*
Signature
*
Clear
