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Request for Shutdown <br />Orange County, North Carolina <br />To be completed by the requester <br />Building: ____________________________________ <br />Address: _ ___________________________ <br />Project:________________________________________ <br />Planned Start Date: ____________ Time: ___ Duration: _ ___________ <br />Description of Work: <br />_____________________________________________________________________________________ <br />_____________________________________________________________________________________ <br />_____________________________________________________________________________________ <br />_____________________________________________________________________________________ <br />Equipment to be shut down: _____________________________________________ <br />Equipment / Services that will be interrupted by this shutdown: <br />_____________________________________________________________________________________ <br />_____________________________________________________________________________________ <br /> <br />Requested by: _ ___________________________________ Date: ________________ <br />Title: _ ________________________________________________________________ <br /> <br />To be completed by the owner/occupant of the affected area <br />When is the next available date for shutdown? __________________________ <br />The above requested equipment shutdown is: __ Approved __ Denied <br />If the shutdown is denied, provide reason for denial <br />_____________________________________________________________________________________ <br />_____________________________________________________________________________________ <br />Orange County Area Owner _____________________________ Date _______________ <br />Title ____________________________________ <br /> <br />DocuSign Envelope ID: 83115E6C-E328-4C43-8E3A-42C2A7503DB8