| THE CITY OF BALCH SPRINGS\nGROWING COMMUNITY\nRight of Way Permit Application\n13503 Alexander Road | Balch Springs, TX 75181 | 972-286-4477\nComplete both pages and attach a site plan showing the location and scope of work. Submit for City review before beginning work. Use additional sheets if needed.\nROW permit fee: $50.00\n1 Applicant and responsible parties |
| Applicant or company name |
| Mailing address, city, state and ZIP |
| Contact name and title |
| Phone | Email |
|---|
| Contractor or utility owner | City registration number, if applicable |
|---|
| On-site supervisor | 24-hour contact phone |
|---|
| 2 Work location and schedule |
| Work address or location |
| Street limits / nearest cross streets / side of street |
| Project name or reference number | Utility or facility owner |
|---|
| Proposed start date | Proposed completion date |
|---|
| Proposed workdays and hours |
| Check all affected areas |
| ☐ Street ☐ Sidewalk ☐ Alley ☐ Parkway / verge ☐ Other |