Electrical Duct Bank Excavation Permit

Permit No.

Date Issued

Project Name

Location

Requested By

Contractor

Scope of Excavation

Excavation Details

Start Date

End Date

Excavation Depth (m)

Excavation Length (m)

Relevant Drawings / Documents

Utility Clearance

Utility	Clearance Obtained	Remarks
Electrical
Water
Sewer
Telecom
Others

Risk Assessment / Safety Precautions

Additional Notes

Approvals

Prepared By

Checked By

Approved By

Date Approved