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Registration Application Page 1 of 2 September 2012 <br />CITY OF LAKE ELMO <br />3880 Laverne Avenue North <br />Lake Elmo, Minnesota 55042 <br />Phone: 651.747.3900 <br /> <br />RIGHT-OF-WAY REGISTRATION APPLICATION <br />Are you a new Applicant or updating information New Applicant Update of Information <br />REGISTRATION INFORMATION (Company Information) <br />Name: <br />Address: <br />City: State: Zip Code: <br />Phone: Fax No. Email: <br />GOPHER STATE ONE CALL INFORMATION (If Applicable) <br />Operator Registration No.: ID No.: <br />LOCAL REPRESENTATIVE (Person Responsible for Fulfilling Obligations of Registrant) <br />Name: <br />Address: <br />City: State: Zip Code: <br />Phone: Fax No. Email: <br />Contact No. 1 Contact No. 2 Contact No. 3 <br />Name: <br />Phone No.: <br />Pager No.: <br />Fax No.: