Country Estates-WO 921119 City of Coppell
Water Utilities
Water Isolation Request
The following information must be provided in order to allow
isolation of any part of the City of Coppell Water System. This
form must be completed and submitted to the Utilities Division for
processing forty-eight (48) hours prior to the date the isolation
is requested.
Time: /~.'3~ A/~f ~./P.M. Date: //-- / ~-- f~
Project Name: .~~ ~ ~~/~ ~. ~ ~ ~
Contractor: ~ ~,,/~
e res ntative :
Contractors
~ea Affected (Street, Block No.):
Time On:
Water Main Size:
Water Service:
/
Water Department Notified:
Time:
~/P.M.
A.M.~
Inches
Inches
If water customers of the system will be affected, contractor shall
provide a list of each of those business or residential structures
affected.
* Note:
The City of Coppell Utilities Division shall perform all
water lihe shut-downs. Contractors are not per~%itted to
turn any valves in the system.
Signed:
Contra~ Representative . Date