CITIZENS COMPLETION FORM

Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.

Is the 811 locate complete? If yes, the 811 locate will expire and will not be renewed.:

Date of Installation:

Work Order Number:

Subdivision / Lot #:

Address/ Town:

foreman name and phone number:

Who completed bell hole:

Who completed meter set:

Attach first picture of job site prior to construction:

No File Chosen

File uploads may not work on some mobile devices.

Attach picture of meter set/ service riser:

No File Chosen

File uploads may not work on some mobile devices.

Attach picture of flagged service route:

No File Chosen

File uploads may not work on some mobile devices.