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2. Notice
   This page is intended for Franchise Utilities to communicate with the City of Midland about where and when they will be doing work within the city limits. If you need to file a request with a Franchise Utility, please contact them directly for assistance.
6. Franchise Utility Company*
   -- Select One --OncorAT&TSuddenlinkAtmosSharrylandOther
8. Name of Franchise Utility Company*
10. Anticipated Date of Work*

    Day, Month, & Year

12. Anticipated Length of Work*

    (ex: 1 day, 2 weeks, 30 days, etc.)

14. Will the Work Take Place in a Street or Alley?*

    1. Street
    2. Alley
16. Street or Block Number*
17. Street Name*
19. Block Number*
20. Street Name*
21. Even or Odd Side?*

    1. Even
    2. Odd
23. Type of Work to be Performed*

    1. Aerial
    2. Trenching
    3. Boring
    4. Other
25. Is the Work "Emergency" or "Routine?"*

    1. Emergency
    2. Routine
27. Description of Work *
29. Upload Copy of Plans (Required)*
33. Contractor Information
35. Company*
37. Contact Name*
38. Contact Phone Number*
40. Email Address*
42. Additional Information
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit Submit and Print

* indicates a required field