The undersigned having complied with all the requirements of the Revised Code of St. Louis, including rules and regulations authorized relative to the installation and maintenance of wires, underground conduits and other telecommunications facilities, makes application for permission to:

(Describe project in detail showing all public and private right of way, road widths, approximate centerline, edge of pavement, right of way edge (both improved and unimproved), all underground utility locations, locations of start and end stations, construction staging pad areas and construction site access and/or construction easement locations (whether they are public, private, temporary or permanent).

   

Status of Applicant (check one)

Local exchange carrier (Chapter 23.34)
Private licensed builder (Chapter 23.64)
Competitive access provider (Chapter 23.64)
Non licensed builder

Applicant Company:

Date:

Address:  

City:     State:     ZIP      

Contact Person:     Telephone:  

Name of Contractor to do work, if known: