Jackson, NY · Washington County
Work Permit Application
The Town of Jackson application requests permission for residents, businesses, or contractors to perform specified work on a town road.
What this form is
Use this application to request a permit for work on a Town of Jackson road, including installing or repairing utility pipes, moving a building, constructing a driveway, setting poles, or burying cable. It asks for the applicant’s contact details, road and work location, work dates, and signature. The permit includes conditions covering traffic, safety, insurance, liability, and restoration of the highway.
Who needs it
Residents, businesses, and contractors planning the listed work or other work on a Town of Jackson road can use this application to request permission.
How to submit it
Submit the completed application to the Town of Jackson Highway Department, 149 County Route 62, Cambridge, NY 12816; the form lists phone and fax numbers but no email or online submission method.
About notarization
This application is signed and dated without a notary; the form contains no notarized or sworn attachment, so the applicant just signs and dates it.
How to submit this form
- 1
Download The Application
Download the Town of Jackson Work Permit Application PDF.
- 2
Complete The Application
Provide applicant contact details, select the work type, describe the road location, enter planned dates, and sign and date the application.
- 3
Review The Permit Conditions
Read the listed conditions on traffic, safety, insurance, liability, and highway restoration.
- 4
Submit To The Highway Department
Deliver the completed application to the Town of Jackson Highway Department at 149 County Route 62, Cambridge, NY 12816.
Frequently asked questions
- What work does the Jackson Work Permit Application cover?
- It lists sewer or water main repairs or installation, gas pipe work, moving buildings, driveways, new poles, buried cable, and an option for other work.
- What information does the application ask for?
- The form asks for the applicant’s name and contact details, the town road and work location, the planned work dates, and a signature and date.
- Do I need a notary for the Work Permit Application?
- No. The application is signed and dated without a notary, and the form does not identify a notarized or sworn attachment.
- How do I submit the Work Permit Application?
- Submit it to the Town of Jackson Highway Department at 149 County Route 62, Cambridge, NY 12816. The form lists phone and fax numbers, but no email or online submission method.
Need something notarized?
This Work Permit Application doesn’t need a notary — but if you have another Jackson form that does, a commissioned online notary can help.