Attach 7 - Excavation permit request Form.pdf
PDF 18 KB Posted
- Attached to
- ROADWAY & SITEWIDE IMPROVEMENTS Federal contract opportunity
- Solicitation number
- 70FA5025R00000012
About this file
This is a blank FEMA Excavation Permit Request form for Mount Weather, designed to document and track proposed excavation activities across multiple utility sectors. The form contains five sections for different utility types: Water, Sewer & Mechanical Utilities; Electrical & Control Utilities; Telecommunications Utilities; Other Utilities; and a main section for overall request details. Each section provides space for locator information, signatures, telephone numbers, and remarks. The form is intended to be submitted to Production Control via fax, with fields for location of proposed excavation, reason for excavation, requestor details, and utility-specific locator information. The form appears to be an internal administrative document for managing and coordinating excavation activities at the Mount Weather facility, with specific tracking and approval processes for different utility infrastructure areas.
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Text version
FEMA FORM NUMBER PENDING
MOUNT WEATHER
EXCAVATION PERMIT REQUEST
( 9 ) REMARKS:
( 12 ) REMARKS:
( 15 ) REMARKS:
( 18 ) REMARKS:
( 2 ) LOCATION OF PROPOSED EXCAVATION: (Describe in detail. Attach drawing or sketch if appropriate)
( 3 ) REASON FOR EXCAVATION:
( 4 ) NAME, ORGANIZATION,AND TELEPHONE NO. OF
PERSON TO CALL FOR ADDITIONAL INFORMATION:
( 5 ) SIGNATURE OF REQUESTOR:
( 6 ) TYPED NAME, ORGANIZATION AND TELEPHONE NO. OF REQUESTOR:
OTHER UTILITIES
(EXPLAIN IN REMARKS)
( 16 ) NAME, AND TELEPHONE NO. OF LOCATOR: ( 17 ) SIGNATURE OF LOCATOR AND DATE:
Section V
Section I I I
TELECOMMUNICATIONS
UTILITIES
( 13 ) NAME, AND TELEPHONE NO. OF LOCATOR: ( 14 ) SIGNATURE OF LOCATOR AND DATE:
ELECTRICAL & CONTROL
UTILITIES
( 10 ) NAME, AND TELEPHONE NO. OF LOCATOR: ( 11 ) SIGNATURE OF LOCATOR AND DATE:
Section IV
Section I
Section I I
WATER, SEWER &
MECHANICAL UTILITIES
( 7 ) NAME, AND TELEPHONE NO. OF LOCATOR: ( 8 ) SIGNATURE OF LOCATOR AND DATE:
TO: PRODUCTION CONTROL, FAX 2681 ( 1 ) Date:
| 1 Date: |
| 2 LOCATION OF PROPOSED EXCAVATION Describe in detail Attach drawing or sketch if appropriate: |
| 3 REASON FOR EXCAVATION: |
| 4 NAME ORGANIZATIONAND TELEPHONE NO OF PERSON TO CALL FOR ADDITIONAL INFORMATION: |
| 5 SIGNATURE OF REQUESTOR: |
| 6 TYPED NAME ORGANIZATION AND TELEPHONE NO OF REQUESTOR: |
| 7 NAME AND TELEPHONE NO OF LOCATOR: |
| 8 SIGNATURE OF LOCATOR AND DATE: |
| 9 REMARKS: |
| 10 NAME AND TELEPHONE NO OF LOCATOR: |
| 11 SIGNATURE OF LOCATOR AND DATE: |
| 12 REMARKS: |
| 13 NAME AND TELEPHONE NO OF LOCATOR: |
| 14 SIGNATURE OF LOCATOR AND DATE: |
| 15 REMARKS: |
| 16 NAME AND TELEPHONE NO OF LOCATOR: |
| 17 SIGNATURE OF LOCATOR AND DATE: |
| 18 REMARKS: |
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