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Run: Private Utility Locate Customer Authorization Form

A customer authorization form for private utility locate requests outside 811, with site details, scope, access instructions, and signed acknowledgements in ...

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Requestor Information

Requestor Name (required)

Company or Organization

Email Address (required)

Phone Number (required)

Site and Project Details

Site Address (required)

City, State, and ZIP (required)

Project Description (required)

Briefly describe the planned work and why a private locate is needed.

Requested Service Date

Utilities and Scope of Work

Utility Types to Locate (required)

Other Utility Type

Locate Scope (required)

Scope Details

Site Access and Deliverables

Site Access Method (required)

Access Instructions

Deliverable Expectations (required)

Special Instructions

Authorization and Acknowledgement

I authorize the requested private utility locate service at the site listed above. (required)

Yes No N/A

I understand this is a private utility locate service and is not a substitute for 811 public utility marking. (required)

Yes No N/A

I acknowledge that locate results are based on available records, visible indicators, and field conditions, and that hidden or unmarked utilities may exist. (required)

Yes No N/A

Authorized Signature (required)

Signature Date (required)

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Email (required)

Your name (optional)

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