Type Full Name :

Sign With Hand

Excavation / Opening Information

City

2 Year Cash Repair Deposit

Is the opening within 200 feet of a gas pipeline?

ZIP

Proposed Date of Completed Restoration *

Proposed Completion Date *

2. $50,000 Performance Bond on record for Contractor

($500 for opening under 20 square feet. $25 per square foot for openings over 20 square feet.

The documents below are required. You can attach them to this application by clicking the Select Files... button.

Contact Person Name *

Borough of
Atlantic Highlands

City

Address or Location

Contractor Information

Phone #

Fee Schedule

Email *

State

Required Attachments

Phone # *

Last Name *

Last Name

Property Owner Information

Purpose of Work *

Dig / Mark Out #

Address

Applicant Information

ZIP

State

1. Certificate of Insurance / Hold Harmless ($300,000 - One Person / $1,000,000 One incident / $500,000 Property)

Street Opening / Curb /
Sidewalk Application

Proposed Start Date *

City *

First Name *

Applicant Signature *

ZIP *

Application Fee - Payable to Borough of Atlantic Highlands.

State

Address

Checklist

Certification

First Name

Phone #

Have you called NJ One Cal? 1-800-272-1000

Address *

100 First Avenue, Atlantic Highlands, NJ 07716
Phone #: (732) 291-1222 | Fax: (732) 291-9725
www.ahnj.com

Will this require additional Traffic Control measures?

Size of Opening (Sq ft)

Company Name *