2. City of Beaumont Water, Sewer and/or Storm Locate Request Submission
4. Company Name Requesting Locate:*
   Reminder this Locate Request is for Water, Sewer and Storm locates only on City of Beaumont Property.
6. Date and Time:*
   Date and Time:

   Date and Time:
8. Contact Name:*
9. Contact Email:*
10. Contact Phone Number:*
12. Alternate Contact:
13. Alternate Phone Number:
15. Date of Excavation:*
    Date of Excavation:
17. Excavation Address:*
18. City:*
19. Province:*
20. Postal Code:*
22. Reason for Excavation:*
24. Area:*
    (Clarify roadway; front, rear, side of property address; N/E/S/W of roadway)
25. Nearest Start and End Intersection:
27. How is the Excavation Area Marked? *
    -- Select One --FlagPaintBoth
28. Attach your Site Plan or Photos*
30. Notes:
34. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that:
    1) your application will not be signed in the sense of a traditional paper document;
    2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and
    3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
35. Electronic Signature*
37. If you have questions contact:

    City of Beaumont

    Public Works

    Phone: 780-929-4306

38. The personal information requested on this form is being collected under the authority of the City of Beaumont Bylaw 382 and Section 33(c) of the Freedom of Information and Protection of Privacy (FOIP) Act. The information collected will be used as for the purpose of setting up utility billing.
    
    If you have any questions about the collection or use of your personal information, contact the City of Beaumont’s FOIP Coordinator at:
    City of Beaumont's FOIP Coordinator
    5600-49th Street
    Beaumont, AB T4X 1A1
    Phone: 780-929-8782
Leave This Blank:


42. Submit

* indicates a required field