Northlake WE P10C-PT 961120Bore/Excavation in Public Right-Of-Way Permit
City of
Date: II /
Permit Issued To: Name:
Address:
Coppe!l - Public Works Department
Project Name: ~l~t'~ ~:~-~
Phone:
~mergency Phone:
Representing:
Inspector:
Phone:
T~ype of Work/General Description:
~[ave ~1 City and/or Franchise utilities Been Contacted a~
Existin~ Utilitie~ Located: YES NO
Will It Be Necessa--~y to Excavate Street, A_~ley or Sidew~
Pavement? YES (attach permit)/NO
Representative(s) of the Franchise/Contractor must adhere to all
construction standards approved by the City of Coppell, which
includes but is not limited to: Compaction of Trenches and Bores,
and Barricading according to the Texas Manual on Uniform Traffic
Control Devices. Area(s) affected must be restored to as good
condition as before the commencement of work.
Any excavation requiring closing of a street or alley must be
reported to the Police, Fire, and Public Works Depa~--tments prior
to closing (462-1144, 462-1133 and 462-8495).
Attach Work Order (Franchise Only)
PAGE 2
PERMIT
Attach Rarricading/Detour Plan if a lane or street closure is
applicable.
Date
Franchise Inspector/or City Inspector
Date
I~zf- ~(; Date '
Appro~ec/C~ Representative
Aoo!icant shall indemnify and forever hold harmless aqains~ each
a~ eve~/ claim, demand or cause of action tha~ may be made or come
against it by reason of or if any way arising out of the closure,
blockinq, excavating, cutting, tunneling, or other work by the
applicant under pe-~mit from the City, if such permit is granted.
PERi, IT. PIIB
Ail contractors will contact Public Works @ 462-8495 to have
trenches and/or open cuts inspected prior to back fill operation
taking place. Staff will be sent to inspect the project.
* NO W-ET BORES ALLOWED!
~ ~"'~, The City With A Beautiful Future
~T~EET/UTILITIES DMSION
732 D~OP~HT P.D.
P.O. BO]~ 478
COPp~LL, TF-~J 7S019
FAX ~l (214) 304-3S47
FAX MAIL COVER PAGE'
pLEASE DELi~ PAGES TO:
TRANSMITTED BY: ~'~'
OUR FAX ~ 214-304-3547
NUMBER OF PAGES (INCLUDING COVER SHEET)
*If you do not receive all of ~he pages, please call back as soon
al possible. Telephone NoS (214) 304-3545 Or 304-3546
Mat~ ~alt~ ~Uplrin~endlnt of ~lic ~l~s
,~ '.: .~.