Charge [ ] Paid [ ]
Permit No. U__________
District No. __________
Date _______________, 20___
PERMITTEE'S
NAME__________________________________________________
Address ________________________________________________ Telephone No.
_________________
_______________________________________________________
Your request for permission to install a _________________________ line along and/or across County Road No. __________ _________________ at (Street address) ________________________ is granted subject to the following terms and conditions:
GENERAL
IT IS UNDERSTOOD that the Permittee will
cause the installation at no expense whatsoever to Mesa County and that the Permittee
will own the same after installation.
Where installation crosses beneath any ditches, canals or water carrying structures whenever possible, it shall be pushed through and beneath in a pipe of larger diameter thereby eliminating the necessity of trenching unless the administering authority allows otherwise. In no case shall the flow of water be impaired or interrupted, unless approved in advance by the administering authority. This work must be accomplished in accordance with accepted good practices and conform to the recommendations of the National Electric Safety Code and to such statures as are applicable. Permittee will be required to shut off lines and remove all combustible materials from the road right-of-way when requested to do so by the Engineering Department or Road Department because of necessary road construction or maintenance operations. If the Engineering Department so requires, Permittee shall mark this installation with markers acceptable to the Engineering Department at the locations designated by the Engineering Department. It is intended that the utility's standard markers may be used. The traveling public must be protected during the installation with proper warning signs or signals both day and nights. Warning signs and signals shall be installed by and at the expense of the Permittee and in accordance with the Manual On Uniform Traffic Control Devices. The Engineering Department may require a construction signing plan prior to the granting of this permit. If proper signs are not in place during the work, the Engineering Supervisor or authorized representative shall immediately stop all work until proper signs are in place.
BACKFILL
The (proposed Utility)
_______________________ shall be installed within the right-of-way at a depth of
______________ (24 inches minimum). The backfilling within the roadway prism
shall be made in six-inch lifts and mechanically compacted and densified to 90%
density around the utility, and 95% density for the remaining portion of the
trench between the base course and the utility. Backfill outside the roadway
prism shall be compacted to a density consistent with the adjoining area but in
no case less than 85% density. Percentages shall be determined by AASHTO T99,
with the material within one percent of optimum moisture. Backfill material
shall be of clear random (non-granular) material. Bedding material may be
granular. Granular backfill may be authorized on a case by case basis. If
granular backfill material is used, compaction shall be a minimum of 70%
relative density. Imported backfill (Class 1 or 2 as defined by the Department
of Highways, Division of Highways, State of Colorado, Standard Specifications
for Road and Bridge Construction, latest edition) may be used or required when
existing material is unsuitable.
BORING
Where the installation crosses an
asphaltic surfaced roadway the installation shall be installed by boring or
jacking through beneath the road surface; however, open cutting shall be
allowed up to the edge of the shoulder portion of the road. No water shall be
used in boring and no tunneling shall be permitted.
WHEN PAVEMENT CUTS ARE PERMITTED
1. An unsuccessful attempt has been
made to bore or jack the installation.
2. Conflicting utilities place constraints as to elevation or alignment on the
proposed installation.
3. Connecting to an existing utility or installation located beneath the paved
portion of the roadway.
4. Otherwise approved in advance.
5. Cutting existing asphalt shall be accomplished so as to provide a neat even
line perpendicular to the centerline of the roadway, unless otherwise approved
by the County Engineering Supervisor in advance.
When an open cut is allowed, the Permittee shall be responsible for backfilling and compacting as described in the BACKFILL section of this permit. The Permittee is responsible for restoring the disturbed portion of the roadway to its original condition. The disturbed area shall be repaired within 48 hours from the time of excavation or 24 hours from completion, of backfilling, whichever is greater. Hot Bituminous Pavement Mix Grade D or E as defined by the Department of Highways, Division of Highways, State of Colorado, Standard Specification of Road and Bridge Construction, latest edition, shall be used for patching material, except when unavailable, during which time a temporary cold mix patch shall be allowed. Temporary patches shall be replaced with hot mix patched within five working days after material becomes available. All disturbed areas to be patched shall be Prime Coated with MC-70 or the equivalent and applied at the rate of 0.15 - 0.30 gallon per square yard. Thickness layer of patching shall not be less than 3 inches.
COMPACTION
Permittee will be required to perform
compaction control testing in accordance with schedule on reverse side.
Permittee shall be responsible for patch failure due to consolidation of
backfill and subsequent surface settlement for a period of eighteen months after
completion of patching, Repairs to failed patches shall be made by the Mesa
County Road Department and billed directly to the permittee, or owner-utility.
PLOWING
Utility placement by plowing shall be
allowed only when approved in advance by the Engineering Supervisor. Permit fee
shall be determined in accordance with the Fee Schedule.
Where plowing operations occur across improved surfaces or within the roadway prism and result in an open cut, backfilling shall consist of fine grained granular aggregate compacted to 85% minimum relative density. Permanent surfaces shall be replaced where crossed with a minimum patch width 12 inches wider (6 inches per side) than the surface damaged by plowing.
SPECIAL PROVISIONS
_____________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
AGREEMENT
The Permittee shall agree to hold the
County of Mesa, the agencies thereof, and their officers and employees harmless
from any and all loss and damage which may arise out of or be connected with the
installation, maintenance, alteration, removal, or presence of the installation
herein referred to or any work facility connected therewith, within the area
covered by this permit, unless loss or damage occurs from their negligence.
This work shall be completed within ______________________ (_______) days from the above date. No work shall be allowed on Saturdays or Sundays unless provided for under Special Provisions. No open trench permitted in traveled roadway after dark, unless otherwise specified in Special Provisions. In the event that road improvements within the right-of-way existing at the time of utility installation is necessitated for any reason the utility agrees to relocate at its sole expense to a location not in conflict with the proposed roadway, the reasonable advance notice, from the County Engineering Supervisor. Mesa County will not be responsible for any damage to any installation placed inside County Right-Of-Way limits, occurring due to normal maintenance activities.
MESA COUNTY ENGINEERING DIVISION
_____________________________________ Applicant
BY: _____________________________________
Mesa County Road Inspector (Date)
In accepting this Permit the undersigned, representing the Permittee, verifies that he has read and understands all of the foregoing provisions: that he has the authority to sign for and bind the Permittee: and by virtue of his signature the Permittee is bound by all the conditions set forth herein.
A SKETCH MUST BE PROVIDED
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