Fillable APPLICATION FOR UTILITY MAINTENANCE PERMIT (City of Lakeway)

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APPLICATION FOR UTILITY MAINTENANCE PERMIT (City of Lakeway)

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The APPLICATION FOR UTILITY MAINTENANCE PERMIT (City of Lakeway) form is 1 page long and contains:

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  • 4 check-boxes
  • 28 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Lakeway

BROWSE CITY OF LAKEWAY (TX) FORMS

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Building & Development Services
1102 Lohmans Crossing, Lakeway, TX 78734
Phone: (512) 314-7540 Fax: (512) 314-7541
www.lakeway-tx.gov
APPLICATION FOR UTILITY MAINTENANCE PERMIT
(INCLUDE A SKETCH SHOWING THE LOCATION OF PROPOSED WORK)
U
TILITY
P
ROVIDER
:
C
ONTACT
:
T
ELEPHONE
:
E-M
AIL
:
M
AILING
A
DDRESS
:
C
ITY
:
S
TATE
Z
IP
C
ODE
C
ONTRACTOR
:
C
ONTACT
:
T
ELEPHONE
:
E-M
AIL
:
M
AILING
A
DDRESS
:
C
ITY
:
S
TATE
Z
IP
C
ODE
DDRESS OF
ROPOSED
ORK
ESCRIPTION OF
ROPOSED
ORK
ROVIDE A
EPARATE
RAWING
HOWING
HE
OCATION
F
ORK
E
STIMATED
S
TART
D
ATE OF
W
ORK
:
E
STIMATED
C
OMPLETION
D
ATE OF
W
ORK
:
D
O YOU PROPOSE TO CUT ANY PAVEMENT
?
I
F YES
,
LIST THE SIZE OF THE PROPOSED CUT
(
IN FEET
):
Y
ES
N
O
Depth:
Width:
Length:
D
O YOU PROPOSE TO CUT ANY DRIVEWAYS
?
I
F YES
,
LIST THE SIZE OF THE PROPOSED CUT
(
IN FEET
):
Y
ES
N
O
Depth:
Width:
Length:
(FOR CITY USE ONLY)
S
UBMITTAL
V
ERIFICATION
:
Repairs of City of Lakeway streets shall be in strict accordance with the City of
Lakeway Ordinances. Adjacent property owners shall be contacted and
informed of proposed work. All areas affected by this project must be returned
to original conditions.
Applicants shall contact all of the utility service providers and comply with the
Underground Facility Damage Prevention and Safety Act, Tex. Util. Code
251.001, prior to beginning. Except as otherwise provided by applicable law,
applicants will be responsible for any damage to utilities or other improvements
in connection with the repair work. A certificated telecommunication provider
shall indemnify the City of Lakeway pursuant to Tex. Loc. Govt. Code 283.057
from any claims and damages arising out of any repair work.
Applicants shall notify the Lakeway Director of Public Works a minimum of
one (1) hour after placement of flowable fill and again after final surface layer
of asphalt is placed.
Under this permit, the applicant (utility provider) shall
warrant all street repairs included in this permit for a period of two (2) years.
P
ERMIT
N
UMBER
:
D
ETERMINATION
:
D
ATE
:
N
OTES
:
A
PPLICANT
S
IGNATURE
P
RINTED
N
AME
D
ATE
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APPLICATION FOR UTILITY MAINTENANCE PERMIT (City of Lakeway)

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Completed 3 August 2020

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