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2. Please fill out this form as accurately as possible. If you have any questions / concerns you may contact the Rogers Fire Department at 479-621-1179.
4. How deep is the trench?*
   You are not required to report it to the Fire Department if it is less than 5 feet in depth.
5. 2. Do you have proper shoring equipment (trench box, etc.) on site?*

   1. Yes
   2. No
7. Contact Name*
8. Contact Phone Number*
10. Address (If one has not been assigned, name closest intersection)*
12. Location of Trench*
    Give a description of the location of the trench (I.e. NW Corner of intersection, west side of property, etc)
14. Dates trench is to be open or under construction (approximate)*
    Dates trench is to be open or under construction (approximate) Start Date

    —

    Dates trench is to be open or under construction (approximate) End Date
Leave This Blank:


15. 1. Receive an email copy of this form.
16. Email address

    This field is not part of the form submission.

17. Submit

* indicates a required field