Northlake WE P10A-PT 921102Bore/Excavation in Public Right-Of-Way Permit
City of Coppe!l - Public Works Department
Date:
Permit Issued To: Name:
Address:
tl / ~ /~ Project Name:
Phone:
Emergency Phone:
Representing:
Inspector:
Type of Work/General Description:
Phone:
catio. of Work: t /%/ c e25
IIave All City and/er Franchise Utilities Been Contacted and
Existing Utilities Located: ~ YES NO
will It Be Necessa_~y to Excavate Street, Alley or Sidewalk
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 Departments prior
to closing (462-1144, 462-1133 and 462-8495).
Attach Work Order (Franchise Only)
PAGE 2
PERMIT
Attach Barricading/Detour Plan if a lane or street closure is
applicable.
~ ~f3~ ac~or~e~reTentat~ve
Franchise/Co~ t p '
Franchise Inspector/or City Inspector
Date
Date
Applicant shall indemnify and forever hold harmless against each
and every claim, demand or cause of action that may be made or come
against it by reason of or if any way arising out of the closure,
blocking, excavating, cutting, tunneling, or other work by the
applicant under permit from the City, if such permit is granted.
PERMIT. PHB
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8ETHEL SCHOOL
BLUE j~y LN
0607 I