12 Utility Acceptance Review Request Form18-Utility Approval
16-2016 Page 1 of 1
CITY OF SCHERTZ
REQUEST FOR REVIEW
Utility Acceptance
Date: ___________________
APPLICANT INFORMATION:
Applicant: _______________________________________________________________________________
(Company Name/Contact person/Title)
Street Address, City, State, Zip: __________________________________________________________________
Ph#: ________________________ Fax#: ____________________ E-Mail: ________________________
PROPERTY DESCRIPTION:
Name of Subdivision/Development: _________________________________________________________
Lot: ________ Block: _________ Address: _______________________________________________
Survey Name: _____________________________________ Abstract#: __________ Tract # _______
Location of Property: ________________________________________ MAPSCO Ref # ________________
I _________________________________ have reviewed and approved this plan as submitted for easements and (Print name of reviewer)
availability where it concerns ______________________________________________.
(Name of Utility Company)
Signed this __________day, of ___________________ Month, 20____.
________________________________________________________ (Reviewer’s Signature)
UTILITY AGENT INFORMATION:
*** Please return this completed form to the applicant noted above. ***
Company: _________________________________ Name/ Title: ___________________________________
Mailing Address: _________________________________, _________________, _________, ______________
(Street) (City) (State) (Zip)
Phone: (____) _______-_____________ Fax: (____) ______-___________