RFPAttachment8FHLForm6A.PDF

FORT HUNTER LIGGETT

DIRECTORATE OF PUBLIC WORKS

EXCAVATION PERMIT

THE REQUESTED INFORMATION MUST BE PROVIDED AND SIGNATURES OBTAINED PRIOR TO

AN EXCAVATION PERMIT BEING SUBMITTED FOR FINAL APPROVAL. ANY DIGGING OR

DISTURBANCE TO SOIL SURFACE WILL REQUIRE A PERMIT. FINAL REVIEW AND APPROVAL

WILL BE GIVEN BY THE CHIEF OF ENGINEERING SERVICES DIVISION, DIRECTORATE OF

PUBLIC WORKS, BUILDING 232, PHONE 831-386-2429. EXCAVATION PERMITS ARE GOOD FOR 10

WORKING DAYS FOLLOWING THE PERMIT APPROVAL’S DATE. A NEW PERMIT APPLICATION

MUST BE SUBMITTED IF THE ORIGINAL PERMIT APPROVAL’S DATE IS EXPIRED.

Requested By:

Company/Organization:

POC Phone(s):

POC E-Mail(s):

Requested Excavation Date:

Brief Description of Construction Project:

Project Number and Title:

NOTE: NEC and/or Dig Alert to locate and field identify mark lines, fiber optics or same other. DPW O&M to locate underground utilities: water, gas, sewer and or electric. If no dates are indicated for utility identification and markings, no excavation permit will be issued until a scheduled date has been indicated above. Dig Alert Ticket No.: ________________

NOTIFICATION REQUIREMENTS:

Will excavation require road closure/power/water or gas outage (YES/NO): ____________.

If YES:

Outage Type: ______________________________________________________________________________

Location: _________________________________________________________________________________

Dates: ___________________________________________________________________________________

Requester to notify DPW O&M Div. Bldg. 151, a minimum of 14 calendar days prior to the requested outage date. If a road closure or utility outage is requested, the following additional endorsements are needed before a permit will be approved:

WARNINGS, CAUTIONS, KNOWN CONDITIONS OR COMMENTS ABOUT CONSTRUCTION

SITE OR AREA OF EXCAVATION (TO BE COMPLETED BY INTERESTED PARTIES)

FHL Form 6A, APR 12 shawn.reinhart Typewritten Text

ATTACHMENT 8, W9124J-12-R-0015

shawn.reinhart Typewritten Text

ADDITIONAL REQUIRED ITEMS:

No excavation permit will be issued without first submitting a google map showing the exact location and dimensions of the proposed excavation.

MANDATORY REVIEW AND SIGN-OFF

APPROVE

ORGANIZATION BLDG SIGNATURE & PHONE NO. ACKNOWLEDGE DATE

DPW O&M Utilities Marked 151

NEC 197

Installation Safety Officer 286

DPTMS, Range Control (*) 320C

DPW Environ. Compliance 233

DPW Natural Resources 233

Dir. Emergency Services 235

Fire Department 120

Provost marshal 236

Medical Aid 210

Master Planning 232

(*) Contractor to schedule a UXO briefing prior to performing any work. Contact the Range Control Office:

Donald Nead at (831) 386-2310 or Arthur Watson at (831) 386-3145

STIPULATION

Due to potential environmental hazards and protected status of natural and cultural resources, the following stipulation applies to all permits issued by the DPW. If any unexpected sub-surface material or conditions are encountered, which includes but not limited to storage tanks, burrowing animals, archaeological artifacts, or anything uncommon, the excavation is to STOP immediately. The DPW is to be notified of condition. Individuals performing any type of excavation without a permit and/or found not following defined restrictions and/or not reporting unexpected sub-surface material or conditions encountered will be in violation of this stipulation. These individuals will be considered liable for any penalties, civil or criminal, that result from their actions.

The requested area to be excavated shall be toned prior to digging.

Requester’s Signature:

(indicates understanding of stipulation)

Printed Name:

Date:

Chief, Engineering Plans & Services Division Approval Date

FHL Form 6A, APR 12