2. City of Bay City Private Utility Permit
   Bay City Contact Information: (989) 894-8181, [email protected]
4. Utility Company*
6. Work Site Address*
7. Contact Name*
9. Email Address*
10. Phone Number*
12. City*
13. State*
14. Zip Code*
16. Description and Purpose of Encroachment*
18. Space and Construction Requirements

    Select all that apply

    1. Road Cuts/Closures
    2. Sidewalk Cuts/Closures
    3. Outlawn Work
19. Time Period (actual scheduled work dates)*
    Time Period (actual scheduled work dates) Start Date

    —

    Time Period (actual scheduled work dates) End Date
21. Temporary Traffic Control Plan
22. Drawing, Site Plan, or Map
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field