Fillable City of Norfolk Worksheet for Street Excavation Permit (City of Norfolk Nebraska)

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City of Norfolk Worksheet for Street Excavation Permit (City of Norfolk Nebraska)

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innovation. right at home.
Norfolk Fire Division
Prevention Bureau
701 Koenigstein Avenue
Norfolk, NE 68701
P402-844-2060 F402-844-2069
www.ci.norfolk.ne.us
City of Norfolk
Worksheet for Street Excavation Permit
D
ate ___________________
PERMIT TO STREET BREAK
Applicant ______________________________ Phone Number _____________
Location __________________________________________________________
Specific Information Concerning Job ____________________________________
__________________________________________________________________
Owner ____________________________________________________________
Bill to ____________________________________________________________
Bill to address ______________________________________________________
_____________________________________________________
Amount of Payment for Permit Fee $375 .
□ Engineering Contacted/Approved ____________________________________
□ Streets Contacted/Approved _________________________________________
Information taken by _________________________________________________
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Rev 6-2015
Planning & Development
Building Services
309 North 5th Street
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City of Norfolk Worksheet for Street Excavation Permit (City of Norfolk Nebraska)

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Completed 10 November 2021

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