Land Use Permit Application

Apply

To request a new land use permit, complete the form below then attach all necessary documents, forms, sketches and/or plans on the next page. You'll be able to review your request before it's submitted to a permit officer for review.

Applicant

Agent

Fee

Surety

Surety shall be based on the estimated cost of work to be performed within the right-of-way. Forms of Surety: Cash or Check, Insurance Surety Bond, Bank Irrevocable Letter of Credit (single use permits only), Resolution (governmental customers).

Request

days

Location

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Attachments

Additional forms are required for a land use permit application, and they depend on the type of activity to be performed.

Click here to view and download all possible land use permit forms

Add files
To attach files, drag and drop them here or click the "Add files" button above.
(JPG, PDF, PNG, or TXT that are 100MB or less)
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Applicant

Name:
Driver's license or tax ID number:
Address:

,
Contact name:
Email address:
Business phone number:
24 hour phone number:
Business fax number:

Agent

Name:
Driver's license or tax ID number:
Address:

,
Contact name:
Email address:
Business phone number:
24 hour phone number:
Business fax number:

Surety

Surety option:
Surety posted by:
Surety refund to:
Amount of surety:
Check number:
Surety company name:
Bond number:
LUP-CS cash surety affidavit provided for cash surety?

Request

Request permission to perform the following activity(s) as per attached plan:
Permit term requested:
Estimated cost of work to be performed on VDOT Right of Way:

Location

Name of city, town or county:
Location type:
Route number:
Route name:
From route number:
From route name:
To route number:
To route name:
Latitude:
Longitude:
Tax map number:
Applicant job number:

Attachments

APPLICATION is hereby made for permit as shown on the accompanying plan or sketch and as described below. Said activity(s) will be done under and in accordance with the rules and regulations of the Commonwealth Transportation Board of Virginia, in so far as said rules are applicable thereto and any agreement between the parties herein before referred to. Where applicable agreements may be attached and made a part of the permit assembly including any cost responsibilities covering work under permit. Applicant agrees to maintain work in a manner as approved upon its completion. Applicant also hereby agrees and is bound and held responsible to the owner for any and all damages to any other installations already in place as a result of work covered by resulting permit. Applicants to whom permits are issued shall at all times indemnify and save harmless the Commonwealth Transportation Board members of the Board, the Commonwealth and all Commonwealth employees, agents, and offices, from responsibility, damage, or liability arising from the exercise of the privileges granted in such permit to the extent allowed by law. In consideration of the issuance of a permit the applicant agrees to waive for itself, successors in interest or assigns any entitlements it may otherwise have or have hereafter under the Uniform Relocation and Assistant Act of 1972 as amended in event the Department or its successor, chooses to exercise its acknowledged right to demand or cause the removal of any or all fixtures, personality of whatever kind or description that may hereafter be located, should this application be approved.

If applicable, I agree to pay the full salary and expenses of a state assigned inspector in conjunction with activities authorized under the auspices of a VDOT Land Use Permit.

I hereby certify that I fully understand and agree to comply with all of the requirements associated with the Land Use Permit application, that I have the authority to make the foregoing request, and that the information provided is correct.

Enter your initials to confirm the accuracy of the above information and submit the application for review.
Agent initials:
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