Application for Vegetation Management On State Right-of-Way for Outdoor Advertising Signs
Part 1: Applicant Information
Print Applicant Name:
Mailing Address:
Telephone Number:	Fax Number:
Email Address:
Contact Person:	Telephone Number:
Adjacent landowner name if required:
Adjacent address:	Phone Number:
Part 2: Sign Location Information
City:	County:
Highway Number:	Side of Highway: N S E W
Nearest Reference Post:	Has sign been in place for more than 3 years? Yes No
Sign Face Direction for Vegetation Management: N S E W
Sign Permit Number (if applicable):
Part 3: Documentation to accompany Application Form
1. Submit Sign Work Zone and Cut Zone Inventory Sheets (Exhibits A & B).
2. Submit color photographs as stated in Section 001.02 Work Zone Plan.
3. Submit copy of Performance Bond in the amount of $10,000 with surety.
4. Submit copy of required Liability Insurance as stated in Sections 010.01 through 010.01D.
5. Submit Permit Fee of $50 payable to Nebraska Department of Transportation (NDOT).
Part 4: Conditions of Permit for Vegetation Management including, but not limited to:
All work shall be performed in accordance with all Permit and Policy Guidance Document.
All permits must be present on the site when work is being performed.
Work shall be accomplished during normal daylight hours. No work shall be performed at night, on Saturdays, Sundays or State-designated holidays.
Applicant shall notify the District Engineer or designee at least two working days in advance of changes to the work zones or schedule.

Part 5: Applicant Certification
I have read and understand NDOT’s Guidance Document for Vegetation Trimming and Removal on State Right-of-Way for the visibility of Outdoor Advertising Signs.
I agree with provisions/conditions and legal responsibilities of this Application and the subsequent Permit for vegetation trimming or removal if subject Permit is approved/issued.
Applicant Signature	Date
Part 6: Review by District Engineer or Designee
Pre-Application Site Visit was completed on (date) and Applicant was accompanied by District designee.
All required Documentation has been submitted by Applicant including Work Zone and Cut Zone Exhibits; photographs; copy of Performance Bond; copy of Liability Insurance, and Permit Fee.
Approve or Deny Issuance of Vegetation Removal/Right-of-Way Occupancy Permit
District Designee Signature	Date

Office use only:

The form may be filled out electronically, but when done, it needs to be signed, dated and mailed or faxed to the appropriate District Permit Officer.

District 1

Nebr. Dept. of Transportation

District 1 Permit Officer

302 Superior St

PO Box 94759

Lincoln NE 68509-4759

Phone:	(402) 471-0850

Fax:	(402) 471-3401

District 2

Nebr. Dept. of Transportation

District 2 Permit Officer

4425 S 108th St

PO Box 45461

Omaha NE 68145-0461

Phone:	(402) 595-2534

Fax:	(402) 595-1720

District 3

Nebr. Dept. of Transportation

District 3 Permit Officer

408 N 13th St

Norfolk NE 68701

Phone:	(402) 370-3470

Fax:	(402) 370-3473

District 4

Nebr. Dept. of Transportation

District 4 Permit Officer

211 N Tilden

PO Box 1488

Grand Island NE 68802-1488

Phone:	(308) 385-6265

Fax:	(308) 385-6269

District 5

Nebr. Dept. of Transportation

District 5 Permit Officer

PO Box 220

140375 Rundell Rd

Gering NE 69341

Phone:	(308) 436-6587

Fax:	(308) 633-6614

District 6

Nebr. Dept. of Transportation

District 6 Permit Officer

1321 N Jeffers

PO Box 1108

North Platte NE 69103-1108

Phone:	(308) 535-8031

Fax:	(308) 535-8034

District 7

Nebr. Dept. of Transportation

District 7 Permit Officer

619 Auditorium Dr

McCook NE 69001

Phone:	(308) 345-8490

Fax:	(308) 345-8492

District 8

Nebr. Dept. of Transportation

District 8 Permit Officer

E Hwy 20

736 E 4th St

Ainsworth NE 69210-1215

Phone:	(402) 387-2471

Fax:	(402) 387-1498