IUPPS Locate Request - Citizens

Is this New business work?

Yes No

Citizens Gas Inspector*

Foreman / Superintendent*

First Name

Last Name

Foreman / Superintendent Phone Number*

Customer*

Does this require a sewer locate?*

Yes No

Date of Scheduled Installation*

Customer Name and Contact - Sewer Locate*

County*

Townships*

Subdivision / Lot

Address(es) - (we can call up to five addresses per request as long as the addresses are next door to each other and on the same side of the road)*

Is this a corner lot?

Yes No

Nearest cross street within 1/4 mile*

City / Town*

Check All That Apply*

Inside City Limits Outside City Limits

Depth / Feet (how deep are we going to be). Example: Enter the number '4', for 4 feet.*

Check All That Apply*

Entire property and along street (short side service) Entire property and both sides of street (long side service) 50 feet in all direction at intersection 100 feet in all direction at intersection 150 feet in all direction at intersection 200 feet in all direction at intersection 250 feet in all direction at intersection (outside city limits) 300 feet in all direction at intersection (outside city limits) Main project / Special

Describe area to be located (If options above don't apply please describe what you need located / if a service comes off a different road, please type in the road name below.)

Boring (if so under what road/roads)*

Construction Area marked in white

Yes No

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Date/Time*

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IUPPS Locate Request - Citizens Gas