Laserfiche WebLink
City of Elk River <br /> 13065 Orono Parkway <br />Elk River, MN 55330 <br />Telephone: 763/441-7420 <br />Fax: 763/441-7425 <br /> <br />APPLICATION FOR STREET DISRUPTION PERMITS <br /> <br />Excavation Obstruction <br /> <br />r~Attached Plan Submitted by (Applicant): <br /> Joint Application (Company Names): <br /> <br />GSOC Registration #: Plan #: <br /> <br />Location: <br />From and To (Address/Location):. <br /> <br />Project #: <br /> <br />Applicant: <br />Address: <br /> <br />24 Hour Phone: <br /> <br />City: <br />Contact Person: <br />Cell Phone #: <br /> <br />State: <br />Work #: <br />Pager #: <br /> <br /> Zip: <br />24 Hour #: <br /> <br />General Contractor: <br /> <br />Contact Person: <br />Sub Contractor #1: <br />Sub Contractor #2: <br /> <br /> GSOC Registration #: <br />Work #: <br />Home #: <br /> GSOC Registration #: <br /> GSOC Registration #: <br /> <br />24 Hour #: <br />Pager/Cell #: <br /> <br />Cable TV Cooling Traffic <br />Gas: High Pressure Low Pressur, <br />Electrical, Voltage: <br />Telecomm, II Fiber I l Other <br /> <br />Water <br />Sewer <br /> <br />Conduit (Size & Kind): <br /> <br />Cable (Size & Type): <br /> <br /> Length: <br />Excavation Size: <br /> <br />Ty.n~ nf Mnf~rinl' <br />.qtn ~nh <br />Shoulders: Bituminous <br /> <br />Width: Depth: <br /> <br />Total Linear Footacle Installed: <br /> <br />Gravel Road Signs Culvert Other <br /> <br /> Estimated Starting Dates: Weekend Dates: <br /> Estimated Ending Dates: After Hour Dates: <br /> Date Received: <br /> <br />Applicant's Signature: <br /> Date: <br /> <br />Review Committee: <br /> <br />Yes <br /> <br />Approval Date: <br /> <br />Permit Number: <br /> <br />S:\PLANNING\FORMS\ROWFORM.D0 C <br /> <br /> <br />