Excavation Permit Request

Please print this page and return it to City Hall

DATE OF REQUEST: _________________ CO. JOB #:____________
COMPANY REQUESTING EXCAVATION PREMIT:______________________________________________________
ADDRESS: ___________________________________________________
____________________________________________________________
PHONE NO.: _______________________ FAX: ____________________
REQUEST PERMISSION TO DIG AT:______________________________
DESCRIPTION OF EXCAVATION: ________________________________

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Job start date: ______________ Completion date: _______________
ASPHALT CUT Length:_________ COPY OF INSURANCE ________
Width: _________
Depth: _________
DIRT/LAWN CUT Length: ________ COPY OF BOND ________
Width: _________ Depth: _________
CONCRETE: Length: ________
Width: _________ Depth: _________

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**CALL BLUE STAKES 48 HOURS BEFORE DIGGING**

1-800-662-4111

Applicant:__________________________________ Date:______________
Permission granted by: ________________________ Date: ______________
Received by: ________________________________ Date: ______________
PERMIT NUMBER: ___________

*an inspector may be needed and inspections of all exposed utilities by Corinne City is required.
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