Utility Service Line Maintenance Dig Permit Form
Permit Details
Permit Number
Date
Applicant Information
Company Name
Contact Person
Phone Number
Email Address
Work Information
Site Address/Location
Proposed Start Date
Estimated Completion Date
Utility Type
Water
Sewer
Gas
Electric
Telecom
Other
Type of Work
Maintenance
Repair
Replacement
Installation
Inspection
Description of Work
Site Details / Safety
Excavation Depth (meters)
Traffic Control Plan
Yes
No
Safety Measures
Additional Remarks