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Applicant/Contractor Information
Applicant Last Name
First Name
Address
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Daytime Applicant Phone
(XXX)XXX-XXXX
Applicant Email
Same As Applicant
Contractor Name
Daytime Contractor Phone
(XXX)XXX-XXXX
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Work on behalf of:
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Excavation Information
Address of Work
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Location in Right-of-Way
Excavation Size (Width)
Size and Type of Utility
Excavation Type
Bore
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Parallel Cut
Excavation Location
In Asphalt
Dirt Shoulder
In Sidewalk
Behind Curb
Behind Sidewalk
Curb & Gutter
Will you be widening an existing approach or constructing a new one?
Yes
No
Date to begin excavation
Date to complete surface restoration (7 days after start of excavation)
Additonal Information
[A few sentences to add any clarification that may be needed.]
Attachments [Files must be under 2 MB]
Will you need to close the road for this project?
Yes
No
Attach Traffic Control Plan
[Required]
remove file
[PDF, Word, or TXT files only]
Traffic control plan is required.
;
Attach Map
[Required]
remove file
[PDF, Word, or TXT files only]
A Map is required.
;
Will an above ground or underground facility be installed with this project?
Yes
No
Attach Site Plan
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[PDF, Word, or TXT files only]
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