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2. If the City of Lynn Haven finds it necessary to widen or otherwise improve the road where this construction will take place, the City will not be responsible for any monetary cost that may be involved in the relocation of any sewage, water, reuse, cable TV, drainage lines/ditches or other facilities placed in the City right-of-way by virtue of this construction authorization.
4. Applicant's Name
6. Company Name or Agency
8. Electronic Signature Agreement

   1. I Agree

   By checking the "I agree" box, you agree and acknowledge that your application will not be signed in the sense of a traditional paper document, by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and you may still be required to provide a traditional signature at a later date.
9. Date
   Date
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11. 1. Receive an email copy of this form.
12. Email address

    This field is not part of the form submission.

13. Submit

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