ST9505-WO 951016CITY OF COPPELL
WATER UTILITIES
WATER ISOLATION REQUEST AND/OR METER RELOCATION
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 twenty four (24) hours prior to the
date the isolation is requested.
Date: /~/~,/~~--
Project:
Contractor: (~~ ~n
Contractors Representative:
Phone
Time:
Area Affected(Street,Block No.):
UU .
Time On:
Water Main S~ze: 1~ Incnes~ ~ ~ /
Water Service: ~-- 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 Coppe11 Utilities Division shall perform
all water line shut-4owns. Contractors are not
~permitted to turn any valves in the system.
/~--- ContraCtors Representative
Date Amount of Payment Initials
* (Attach work order for relocation only)
disk 4 (ISOLATION)