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.
Work will be completed by this date, or this permit becomes null and void.
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