Emergency Sewer Excavation Permit Form
Applicant Information
Company/Contractor Name
Contact Person
Phone Number
Email Address
Company Address
Excavation Site Information
Excavation Site Address/Location
Proposed Start Date
Expected Completion Date
Emergency Details
Description of Emergency
Justification for Emergency Excavation
Excavation Plan
Proposed Excavation Method
Safety Measures/Traffic Control Plan
Utilities Notified/Coordination Details
Authorization
Applicant Name/Signature
Date