Utility Relocation Request Documentation

Project Information

Project Name Project Number/ID Location Date of Request Requesting Organization / Contact

Utility Information

Utility Owner/Company Type of Utility Description of Utility (e.g., size, material, location) Current Location (Drawing/Reference No.)

Relocation Details

Reason for Relocation Proposed Relocation Location Required Completion Date Additional Comments/Instructions

Attachments

List of Attached Documents/Drawings:

Description	File Reference

Approval & Signature

Requested By Date Approved By Date