Small Wireless Facility Encroachment (SWFE)
Small Cell - Collocation on Existing Pole
Small Cell - Install Replacement Pole
Small Cell - Collocation on Replacement Pole
Sewer or Storm Connection
Has 811 been contacted?
Lane or Sidewalk Closure
Installation Type
Road Type
Department of Public Works
3518 Broad Street.
Chamblee, GA. 30341
470 395 2316
Utility Gas Connection
Standard Right of Way Encroachment (ROWE)
Utility Franchise Agreement
Does your work need installation?
Utility Franchise #
Encroachment Details
Film Production: Lane Closure
Parking Lot or Spot Closure
Small Cell - ​Install New Pole
City of Chamblee
Encroachment Permit
Encroachment Type
Utility Fiber Installation
  • Contacts
  • Worksite
  • Additional ROWE
  • Additional SWFE
  • Closures
  • Installation
  • Permanent Structures
  • Certification
Last Name
Address
Name
State
Emergency 24hr Contact Email
Is the contractor the same as the applicant?
Company Name
Phone Number
Applicant Information
Email
Address
ZIP
City,State,ZIP
City
Phone #
Address 2
Emergency 24hr Contact Name
An applicant is defined as an owner of property adjacent to the right-of-way, the property owner's authorized representative, or an authorized representative of a private or public utility who applies for a permit to construct, operate, use, and/or maintain a facility within the right-of-way for the purpose outlined within the application.
City, State, ZIP
Address
Company and Emergency Information
ZIP
First Name
Contractor Information
First Name
Owner Information
City
Emergency 24hr Contact Phone
Email
State
Address
License #
Last Name
Email
Phone Number
City
ZIP
Proposed Finish Date
Street Number
Proposed Start Date
Street
Project Name
State
Worksite Information
Install Road Closure
Permanent Structure
Curb Cut
Vegetation Removal
Film Production: Temporary Structure
Utility Cable Overlash
Additional Standard Right of Way Encroachment (ROWE)
Temporary Structure
Days Closed
Description of work
Land Disturbance (Construction)
Vegetation Planting
Utility Water Line
Additional Work Specifications
Utility Pole Type
Number of Replacement Poles
Number of New Poles
Additional Small Wireless Facility Encroachment (SWFE)
Total Number of Collocation
Lane Closure -​ Local street, partial closure
Parking Closed From
Lane Closure: Feeder -​ Corridor, 200' or greater
Linear Feet of Lanes Closed
Lane Closure: Feeder - Corridor, full closure
Lane Closure Information
Sidewalk Closure: Feeder -​ Corridor, less than 200'
Description of Lane Closure
Length of Sidewalk Closed
Lane Closure: Feeder - Corridor, less than 200'
Local Lane Closure
Parking Lot/ Spot Closure
Number of lanes closed
Feeder Lane Closure
Number of Parking spaces closed
Will your lane closure require police supported traffic control?
Sidewalk Closure - Local Street
Lane Closure -​ Local street, full closure
Sidewalk Closure: Feeder -​ Corridor, 200' or greater
Parking Opens at
Total Length of Bores
Trench Dimensions OUT of Pavement
Pipe Size and Specifications
Trench Dimensions IN Pavement
Installation
Number of Bores
Permanent Structures
If more than one utility pole or facility, buried permanent structure including items such as manholes, handholes, bore pits, service access points, stormwater retention structures, sanitary retention structures, or other utility or buried permanent structures exists. Complete the following table or provide an excel sheet detailing the structure type, plan page number, STA or detail number, address, and GPS coordinates. GPS coordinates are only required for buried items and above ground utilities. Applications that include multiple permanent structures and are submitted without this information will be rejected
Type Full Name :
Sign With Hand
Pictures/Documents
Certification
  • Attach supporting documents here. Supported documents include plans, detailed drawings, 811 notification, permanent structure list and MUTCD complaint traffic control plans for road or walkway affected work including partial obstruction or closures.

  • Please upload any site plans/drawings or the plan for pedestrian control pertaining to your permit application.

  • If multiple handhole, bore pit or permanent structure locations exist, provide excel sheet summarizing the structure type, plan page number, STA or detail number, address, and GPS coordinates.

  • Traffic Control Plan.
  • It is understood that work within City ROW may require temporary traffic control in conformance with the Manual of Uniform Traffic Control Devices.

  • It is understood that if there is damage done to facilities within the ROW I will be liable to repair damages as directed by the City Engineer.

  • The applicant agrees to comply with all Municipal Ordinances and with the conditions of this permit, understands that issuance of the permit creates legal liability, express or implied, on the Department or Municipality, and certifies that all above information is accurate.

  • The applicant shall restore the right of way to the existing conditions as defined by the City Engineer and in accordance with industry standards. By signing, the applicant agrees to provide a guaranty period of one year to which any and all defects identified in the restoration of the site shall be repaired by the applicant, and indemnify and hold harmless the OWNER from all costs and damages incurred as a result of such repairs. Failure to do so may result in the assessment of damages by the OWNER in addition to any future permits being rejected.

  • Applicant agrees to notify the City 24 hours prior to commencing work by emailing encroachmentpermitpw@chambleega.gov.

  • Applicant agrees to notify the City upon completion of work for final inspection and approval by emailing encroachmentpermitpw@chambleega.gov once work is complete.
    • Attachments
    Applicant Signature