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Joint Trench Excavation Permit Application <br />for work in the City Right-of Way or Easement Page 1 of 2 September 2012 <br />PERMIT NO. <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 OR CITY EASEMENT <br />JOINT TRENCH EXCAVATION PERMIT APPLICATION <br />Name and Address of Lead Utility (Permittee): Name and Address of Party Performing Work: <br />Contact: Contact: <br />Phone: Phone: <br />24-Hour Emergency Phone: <br />Email address: <br />24-Hour Emergency Phone: <br />Email address: <br />1. Utility Type: <br />(Check all that apply) <br />Company Name Total Installation <br />Length (Ft.) <br />(Column A) <br /> Joint Trench <br />(Ft.) <br />(Column B) <br /> Additional <br />Footage (Ft.) <br />(Column A–B) <br />Gas Main <br />Gas Service <br />Electric Main <br />Electric Service <br />Telephone Main <br />Telephone <br />Service <br />Cable Main <br />Cable Service <br />Other <br />TOTALS: <br /> Line (1) Line (2) <br />2.Attach Joint Trench installation detail providing surface depths, size and type of pipes, conduits and utilities. <br />Length of joint trench: Dimensions of excavation: <br /> Line (3)