Utility/Right-of-Way Utilization Permit

2. Date/Time*
   Date/Time
4. Utility provider*
6. Applicant email address*
7. Consultant or Secondary email (optional)
9. Applicant phone number*
11. Road number*
13. Site address*
15. Proposed use (equipment being installed, length, directional bore, etc.)*
17. Proposed start date (Must be at least 14 days after the submitted date and within 90 days of the date of application.)*
18. Proposed end date (Must be within 120 days of the date of application)*
20. Please confirm: Is the start date of the work at least 14 days after the submitted date?*

    1. Yes
    2. No - If your answer is No - STOP - Please fix the date.
22. Directions to the site from the nearest intersection*
24. Is the proposed use within the corporate limits of a municipality or community development district (CDD)*

    1. Yes

    1. No
26. Name of Municipality*
28. Name of CDD*
30. Is state or interstate right-of-way involved?*

    1. Yes

    1. No
32. Are any law enforcement services going to be utilized*

    1. Yes

    1. No
34. Officer contact (name & title)*
36. Department*
38. Phone number*
40. Does this permit require an open cut installation across a road or shoulder?*

    1. Yes

    1. No
42. By submitting this permit, the applicant acknowledges the following:
    • The applicant declares that prior to beginning work, he or she will ascertain the location of all existing utilities, both aerial as well as underground, by employing the utility locating service, 811.
    • It is expressly stipulated that this permit is a license for permissive use only and that the placing of facilities upon public property pursuant to this permit shall not operate to create or vest any property right in said holder.
    • Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation, alteration or relocation of all, or any portion of said highway as determined by the County Director of Public Works and/or his employees, any or all of said poles, wires, pipes, conduits, cables or other facilities and appurtenances authorized hereunder, shall be removed from said highway, or reset or relocated thereon as required by the County, and at the expense of the permittee.
    • All work shall meet County standards and The Florida Department of Transportation’s “Utility Accommodation Manual”. All work will be subject to the approval of the Sumter County Director of Public Works and his or her employees.
    • All materials and equipment shall be subject to inspection by the County’s Director of Public Works and his or her employees.
    • All County property and right-of-way shall be restored to its original condition as far as practical, in keeping with County specifications and the Florida Department of Transportation’s “Utility Accommodation Manual” and in a manner satisfactory to the County. Open cuts of road and shoulder pavements are not allowed unless specifically approved by the Director of Public Works. If an open cut is approved, it must conform to the Sumter County Right of Way Utilization Permit typical sections. Jack and bores shall conform to the Sumter County Right of Way Utilization Permit typical sections. Other types of directional drilling between roadways will be submitted for approval. • All installations shall conform to the edition of the Florida Department of Transportation’s “Utility Accommodations Manual,” which is in effect on the date the permit is approved.
    • The permittee shall commence actual construction in good faith within ninety (90) days from the date of said permit approval and shall be completed within days.
    • The proposed use shall not interfere with the property and rights of a prior permittee.
    • The attached sketch or plans, covering details of this proposed use, shall be made a part of this permit. This approved permit with plans and Maintenance of Traffic (MOT) shall be on-site at all times. Use FDOT Design Standards 600 Index Section as applicable.
    • Any material (signs, flyers, etc.) advertising proposed use must be included for review. Details for advertisement methods must be detailed within the site plan.
    • A notarized letter from the property owner authorizing the proposed use for the dates specified in step one must be provided if the permittee is not the property owner.
    • It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the County’s right, title and interest in the land to be entered upon and used by the holder, and the holder will, at all times, assume all risk of and indemnify, defend and save harmless the County of Sumter and the Sumter County Public Works Department and Director of Public Works from and against any and all loss, damage, cost or expense arising in any manner on account of the exercise or attempted exercises by said holder of the aforesaid rights and privileges. During use, all safety regulations of the County and/or the Florida Department of Transportation’s “Roadway and Traffic Design Standards” shall be observed and the holder must take such measures, including placing and display of safety devices, as may be necessary in order to safely conduct the public through the project area in accordance with the County’s safety regulations and/or the Florida Department of Transportation’s “Roadway and Traffic Design Standards”.
    • Approval of this application does not waive any other applicable provisions of the Sumter County Land Development Code, Comprehensive Plan, or Utility Code, which are not part of the request for this application. Nor does approval waive any applicable Florida Statutes, Florida Building Code, Florida Fire Prevention Code, or any other applicable laws, rules, or ordinances, whether federal, state or local. The applicant has the obligation and responsibility to be informed of and be in compliance with all applicable laws, rules, codes, and ordinances.
    
44. The office of the Director of Public Works shall be notified twenty-four (24) hours in advance before starting work.
46. • In the case of noncompliance with any of the provisions of this document, this permit is void and the proposed use will have to be brought in compliance or removed from the right-of-way at no cost to the County.
48. Required attachments
    ---Site Plan - including location, depth of installation, etc.*
50. Applicable MOT*
52. Instructions Link
    Instructions
53. Permit Diagrams Link
    Diagrams
55. Internal Use ONLY
    Permit Number ________________________________
    
    Permit Expiration______________________________
    
    Reviewer Signature_________________________________
    
    Additional Reviewer Comments:________________________________________________________________________________________________________
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56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field