Estates and
Buildings
Title
Underground Services Clearance Request
Serial Number:
To: Electrical Engineer/
From:
Heating Engineer/ Works Manager:
Project Title:
Project Number.
I intend to commence excavation at the undermentioned location and it is requested that you make
known to me the presence, or otherwise, of any: - *electricity cables; telecommunication/computer
services; steam/hot water pipes; fuel pipes; gas pipes; water pipes; sewage pipes (or any service lying
within the area indicated below).
Location (include drawing sketch if
necessary):
Description of Work Undertaken:
Signed:
Date:
*Delete as appropriate
To:
From:
Project:
Project Number:
Your application
Reference:
Dated:
is acknowledged and it is affirmed that:
Signed:
Date:
J:\Standard Forms\Underground Services Clearance Request