APPLICATION FOR PERMIT TO CUT CURB, PAVEMENT OR SIDEWALK

TO THE HONORABLE MAYOR AND COUNCIL OF THE CITY OF O'NEILL, NEBRASKA:

The undersigned hereby makes application, under the provisions of Section 5-317 of the
Municipal Code of the City of O'Neill, Nebraska, for permission to cut the (curb,
pavement, sidewalk) at the following location.

LOT_________BLOCK____________ADDITION______________________________FOR THE PURPOSE OF _________________________________________FOR_____
________________________AT____________________________________________.

Permit Fee of $25.00 has been paid to the City Clerk-Treasurer, date_________________

Deposit $50.00 per foot. Total: _____ft. = $_____has been paid to the City Clerk-Treasurer,
date________

Dated this____________day of______________, 20___.

_________________________________, Applicant

Filed in the office of the City Clerk this __________day of _________________, 20___.

______________________________, City Clerk

Deposit Returned ______________, 20___, by Check No._________.