Helena Township Utility Permit Application

Utility Permit Application

Name of applicant :
Address of applicant:
City: Zip:

Day Phone: Evening Phone:
E-Mail:

Address of work:
City: Zip:

Contractor information:
Name:
Address:
City: Zip:

Nature of work:
Location:
Depth from surface: Work to start on :
Will detour be necessary? : Yes No
Roads involved :

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27466 Delmar Avenue, New Prague MN 56071 - Phone: 952-758-4505 - [Map] - the clerk
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