TYPE OF WORK (To be Completed by APPLICANT)
Describe the type of construction you are applying for in the space below, if there is not enough space attach extra page.
Include public water mains, public sanitary sewer mains, public storm sewer mains, public gas mains, public streets,
erosion controls and drainage facilities (i.e., detention ponds)
Names of all persons contributing to any part of the cost of the construction , whether new or for improvements must be listed with the amount
paid by each for the property listed.
Construction plans with the Engineer's seal must be submitted in duplicate for review for all utility construction permits issued by the
City of Tomball. These plans must reflect all materials to be used and the exact dimensions of the project. All applications and
plans for public utility / ROW construction work are to be submitted to the City Engineer where they will be filed and become public
Construction for will begin on or after the
, 20 .
The map or plat of the subdivision named above is recorded in HCFC or Volume , Page , of
Records of Harris County, Texas.
FOR PUBLIC UTILTY WORK AND PUBLIC ROW WORK ONLY
By signing this section I agree to follow the Code of Ordinances for the City of Tomball and any associated laws applicable in
the City of Tomball, Harris County, the State of Texas and the United States. Therefore I am bound to defend at my own cost
and expense any suit(s), action(s), claim(s) or damage(s) sustained against the City of Tomball for any loss, cost, expense or damage
charged or imposed upon the City for granting this permit. Furthermore, I agree to keep in good repair the refilling and surfacing
necessitated by the excavation covered by this application for a period of one year. I also understand and agree that this permit shall
be granted giving the City of Tomball, or any other person entitled, the lawful right to use said street, alley or other public place. I
understand and agree that should this permit be granted for the purpose of locating or placing any pipe, conduit, duct, tunnel or other
structure there is no fixed or vested right in said location and the City of Tomball, or any other person entitled, has the lawful right to
lay or place its pipes, conduits or other structures in, under, over or across such pipes, conduits or other structures laid without cost or
charge by the prior location for such use. I also understand and agree that these improvements, when constructed, will be public
improvements, the property of the City of Tomball, and without right of reimbursement by the City for any of the costs, except as
stipulated in the CITY OF TOMBALL CODE OF ORDINANCES.
APPLICANT’S SIGNATURE DATE
APPLICANT’S NAME (In Print)
Page 3 of 3
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