Province of Manitoba

Utility Installation Application

Application will not be processed until ALL information is submitted. Please send your project drawings via email to utility@gov.mb.ca in pdf format.

Note: the maximum allowable size of an email we can receive is 10MB.

Utility (Check all applicable) Hydro Electric Water Line Telecommunication Sewer Line Gas Other

Please specify:

Installation Type Below Ground Above Ground

Temporary (Installation in place two weeks or less) Maintenance Service Drops Projects Requested by MI Abandonment Permanent

Application Fee: $

General Information

Highway No.
Highway No.
Highway No.
Highway No.
Highway No.
Highway No.

Please list all affected highways if more than one.

Project Location From: To:

Rural Municipality (if applicable)

City/Town/Village (if applicable)

Drawing Reference No:

Applicant

Contact: Company Name: Address: Town/City: Province/State:

Postal Code:

Zip Code:

Telephone No.: E-Mail:

Is the Owner Information different from the applicant? Yes No

Owner

Contact: Company Name: Address: Town/City: Province/State:

Postal Code:

Zip Code:

Telephone No.: E-Mail:

Proposed Construction Start Date:

Proposed Completion Date

Description of Proposed Project & Justification of Proposed Alignment: Please refer to requirement for permanent or temporary utility installation within highway rights-of-way PDF

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I certify the information submitted on this application is accurate to the best of my knowledge.

Please note your confirmation number appearing on the screen and include this number in the subject line with your drawings.

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