PW UTIL PERMIT
CITY OF SCHERTZ
PUBLIC WORKS
10 COMMERCIAL PLACE, BLDG. #2
SCHERTZ, TEXAS 78154
(210) 619-1800, FAX (210) 619-1849
PUBLIC WORKS PERMIT APPLICATION
JOB ADDRESS: COUNTY:
ZONING: BLOCK: LOT: SUBDIVISION:
OWNER NAME: ADDRESS, CITY, ST. ZIP: PHONE:
CELL:
FAX:
EMAIL:
CONTRACTOR: ADDRESS, CITY, ST. ZIP PHONE:
CELL:
FAX:
EMAIL:
ENGINEER: ADDRESS, CITY, ST. ZIP PHONE: _____________________
CELL: _______________________
________________________________ ________________________________________________ FAX: ________________________
EMAIL: __________________________
DESCRIPTION OF WORK BEING PERFORMED:
BOND OR INSURANCE COMPANY NAME: ADDRESS:
BOND OR INSURANCE COMPANY PHONE NUMBER: COPY OF INSURANCE: YES NO
WILL THERE BE ANY OF THE FOLLOWING PERFORMED:
ROAD BORING STREET CUTS TRENCHING TRENCH DEPTH ______________ IS SHORING NEEDED:
YES NO **NOTE: IF TRENCH IS OVER 5 FEET SHORING MUST BE USED.
WHAT TYPE OF UTILITY LOCATES WERE MADE?
WATER SEWER ELECTRIC GAS PHONE CABLE TV OTHER
START DATE: ESTIMATED COMPLETION DATE:
PRE-INSPECTION: DATE:
COMPLETED INSPECTION BY: DATE:
NOTICE FOR DEPARTMENT USE ONLY
THIS APPLICATION FOR PERMIT SHALL BECOME NULL AND VOID WITHIN 12
MONTHS OF ISSUANCE. ANYONE HOLDING AN EXPIRED PERMIT MAY APPLY FOR
PERMIT NUMBER: ______________________________
AN EXTENSION, IN WRITING. PERMITS ARE NON-TRANSFERABLE FROM ONE
PERSON TO ANOTHER.
PERMIT FEE: ___________________________________
I UNDERSTAND THE CITY OF SCHERTZ TRAFFIC CONTROL PROCEDURES,
PROPER BACK-FILL, STREET CUT, AND SAFETY ORDINANCES OR ANY
ORDINANCE THAT MAY APPLY TO MY JOB. THE CONTRACTOR WILL BEAR THE
TOTAL AMOUNT DUE: _________________________________
COST OF THE CONSTRUCTION WORK PERFORMED BY THE CITY OF SCHERTZ
FOR ANY DAMAGES TO UNDERGROUND/OVERHEAD UTILITIES DUE TO
UNSATISFACTORY WORKMANSHIP. I ALSO UNDERSTAND THAT IT IS THE
APPLICATION ACCEPTED BY DATE
CONTRACTORS AND/OR SUBCONTRACTORS RESPONSIBILITY TO ACQUIRE ANY
AND ALL LOCATES NEEDED FOR THIS JOB.
CITY AUTHORIZATION BY DATE
SIGNATURE OF OWNER, CONTRACTOR OR AUTHORIZED AGENT
PRINT NAME OF OWNER, CONTRACTOR OR AUTHORIZED AGENT
DATE
<DOCUMENT_END>
04-2013 Rev PW