Print application below and mail to:
Lee
Lehmkuhler
508 E. Fourth St.
P.O. Box 10
Huntingburg, IN 47542
City of
Huntingburg
Permit No.___________
Date Received___________
Address of Excavation_________________________________________________________________________________________________________
Reason for Excavation�������������
Sewer������������� Water�������������� Gas����������������� Phone�������������� Storm Drain Other____________________________
Public Property to be Disturbed (circle all applicable)���������������
Street�������������� Alley��������������� Sidewalk Curb��� Paved�� ������ Gravel Grass
Estimated Start Date_____________________________������ Estimated Completion Date______________________________________________________
Owner Name________________________________________
Address_________________________________________________________________����������� Phone______________________________________________
Contractor Name_____________________________________
Address_________________________________________________________________����������� Phone______________________________________________
Names and after-hours phone numbers of Contractor�s contact persons:
________________________________________________________������� ����������� _________________________________________________________
Name and Phone No. Name and Phone No.
Drawing of Excavation: