If different from the Petitioner
Name of road where work will be performed
R _ _ , D _ _ , or S _ _. Refer to Peoria County Map
Address, GPS Coordinates, or Quarter Section
Upload for electronic submittal.
Photographs taken within 6 months of application submittal. Upload for electronic submittal.
See Section 4 below in Regulations and Standards. Upload for electronic submittal.
Applicant shall provide performance bond in the amount of $20,000 or 110% of engineer's estimate of probable cause, whichever is greater. Upload scan of bond for electronic submittal and submit actual bond to County.
Work will be completed by this date, or this permit becomes null and void.
If applicable, submit a copy of the approval from the owner of an alternative antenna structure to mount the wireless telecommunication facility on that specific alternative structure. Also include a determination by the alternative antenna structure owner that the structure is structurally capable of supporting the wireless telecommunication facility. Upload for electronic submittal if applicable.
By checking "I Agree", you agree and acknowledge your electronic signature is valid and binding in the same force and effect as a handwritten signature.
Peoria County Highway Authorized Signature Only
This field is not part of the form submission.
* indicates a required field