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2. 

3. This permit required for all work within public R.O.W. and or public utility easements that contain City of Mansfield utilities. Permit application must be submitted at least one week prior to construction start date. Construction plans shall be standard sheet sizes only (Letter, Legal, Tabloid). The City of Mansfield Utility Department (water/wastewater only) is part of Texas811 (dial 811). It is the responsibility of the contractor to obtain and verify locates have been completed prior to excavation and to have them remarked should the markings fade or disappear. FOR TRAFFIC SIGNAL LOCATES please email Mansfield Traffic Operations at trafficsignallocates@mansfieldtexas.gov

5. Utility Information

7. Utility Company*
9. Utility Company Contact Person*
11. Utility Contact Person Email*
13. Utility Contact Person Phone Number*

17. Contractor Information

19. Contractor*
21. Contractor Address*
23. City*
24. State*
25. Zip Code*
27. Contractor Email*
29. Best Person To Contact*
30. Contractor 24 Hour Phone Number*
34. Location of Project*
36. Description of Work*
38. Construction Start Date*
    Construction Start Date
40. Attachment*
42. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that

    1. acknowledge and understand that this application will take up to five working days to review and process.
    2. your application will not be signed in the sense of a traditional paper document
    3. by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature
    4. you may still be required to provide a traditional signature at a later date.

    1. I agree
44. Electronic Signature*
46. Date of Applicatoin*
    Date of Applicatoin
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field