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2. 
4. PRIVATE PROPERTY PERMISSION FORM for Meadowbrook
6. I, the undersigned Owner of the Property locate at the below address hereby grant Permission to the representatives and assigns of the City of Norfolk (hereinafter “City”), acting through the Director of Utilities, to enter upon the Property, including under any structure, and perform Work, including related surveys, examination and inspections, generally described as follows:
8. Address1*
10. Address Continued
12. City*
13. State*
14. Zip*
16. Description of Work

    Private property assessment for planned sewer service turnaround.

18. The Permission is effective immediately, and it shall remain in effect until 3/31/2022.

    This time shall be automatically extended, if necessary, for performance of the Warranty Condition (See #3 below).  The Owner may rescind this Permission at any time by notifying the Director of Utilities by registered mail at 401 Monticello Avenue, Norfolk, VA  23510.  The registered mail receipt shall serve as evidence of the notice to rescind.  The Owner understands that if he or she rescinds the Permission hereby granted, she or he could be held responsible for performing and/or completing the Work.

    It is expressly understood that the City shall have no obligation to perform any of the Work until such time as the City shall deem it appropriate in its sole discretion.  The Work may be terminated by the City at any time and for any reason at the City’s option and in its sole discretion.  Termination may result from, but not limited to, the necessity for some other (perhaps unanticipated) work be performed by either the Owner or the City prior to, or in order to, complete the Work.  Examples of extra work include (1) the required removal of an underground fuel tank, (2) the existence of hazardous material (E.g., contaminated soil) and (3) the correction of existing, noncomplying work (e.g., plumbing systems).  The performance of the Work is subjected to the following Conditions:

    1. 1. The City shall use qualified contractors and personnel (each licensed as required) to perform Work, obtain all required permits, and comply with all applicable codes.
        
    2. 2. The City shall restore all areas disturbed by the construction activities to a condition functionally and aesthetically similar to the existing condition, generally as follows:
        
       1. 2.1 Grass shall be planted with commonly used seed mixes and planting procedures in all unpaved areas not otherwise landscaped;
           
       2. 2.2 Bushes shall be replanted if practicable, replaced in-kind if locally available, or replaced with similar plants, at the City’s option; 
           
       3. 2.3 Trees shall not normally be disturbed except for minor trimming of branches and roots where pipe must be placed through the root zone.   Reasonable care shall be taken to help assure the survivability of trees; however, the City shall not be held responsible for any loss or damage to trees; 
           
       4. 2.4 Paved areas (asphalt, concrete, etc.) and structures (including fences) shall be restored to their original functional condition or better at the City’s option.
    3. 3. The City shall warrant the Work against defects in materials and workmanship for a period of one year from the date of substantial completion.  Substantial completion means that, in the opinion of the City, the Work is ready to perform its intended primary function.
        
    4. 4. In the event that the Owner hires or contracts with any representative of the City, including but not limited to its contractors or subcontractors, and personnel, for any purpose, the Owner shall hold the City harmless for any loss or damage resulting from any such contractual arrangement.

    The undersigned Owner hereby certifies that she or he owns the Property at the location identified above, and that she or he has the right to grant this Permission to the City to perform the Work in accordance with the above Conditions.

20. By Owner (Electronic Signature): *
21. Date*
    Date
23. Mailing Address*
25. Mailing Address Continued
27. City*
28. State*
29. Zip*
31. Home Phone Number: *
32. Cell Phone Number:
33. Work Phone Number:
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

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