CITY OF CARROLLTON EXCAVATION PERMIT NAME FIRM NAME ADDRESS CITY/VILLAGE STATE PHONE LOCATION OF PROPOSED EXCAVATION NATURE OF EXCAVATION BONDING COMPANY: NAME ADDRESS CITY/VILLAGE STATE PHONE AMOUNT OF BOND $ PREVIOUS EXPERIENCE (LIST CITIES AND/OR VILLAGES) CITY/VILLAGE CITY/VILLAGE OFFICIAL 1. 2. 3. 4. I have read the municipal law with regard to excavations and my firm or company intends to fully comply with the Street Regulations Code provisions. (Applicant’s Signature) CITY OF CARROLLTON APPLICATION FOR CULVERT/DRIVEWAY PERMIT I, ____________________________, do hereby request permission and authority to construct a culvert/driveway on the right-of-way of the City in accordance with the information provided on this application and the accompanying sketch. (Applicant must prepare a sketch showing location, length and pertinent details.) ADDRESS: Pipe material will be: Wall thickness or gauge will be: Type of joint will be: DATED: _________________________, 20__ SIGNED: (APPLICANT) CULVERT/DRIVEWAY PERMIT APPLICATION Approved ( ) Disapproved ( ) If disapproved, state reasons: DATED: _________________________, 20__ SIGNED: CERTIFICATION The undersigned has inspected the construction and installation set forth above and finds that the same (is) (is not) in accordance with the permit. DATED: _________________________, 20__ SIGNED: