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Get FL Form FAC Rule 14-20.010 2008-2022

F.A. C. Rule 14-20. 010 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 850-040-05 MAINTENANCE 05/08 Page 1 of 2 GENERAL USE PERMIT Date Permit No. Name of Applicant or Authorized Agent Entity if applicable If entity furnish contact information for responsible representative Zip Code Address Telephone No. City/State Email Address Activity / Project Site County From Mile Post State Road Section No Construction Proposed or Underway Yes FM Project No. Name of Municipality if Work is within Limits Description of Work Activity General Provisions 1. Attach any pertinent plans or drawings. 2. Attach notification letters sent to any Utilities both aerial and underground that will be potentially impacted. 3. The designated FDOT Engineer shall be notified 48 hours prior to beginning of work. at. Contact 4. All work materials and equipment shall be subject to inspection and approval by FDOT. Attach any pertinent plans or drawings. 2. Attach notification letters sent to any Utilities both aerial and underground that will be potentially impacted* 3. The designated FDOT Engineer shall be notified 48 hours prior to beginning of work. at. Contact 4. All work materials and equipment shall be subject to inspection and approval by FDOT. Applicants certification of work at completion is required* 5. The permittee shall be responsible to place and display safety devices and proper maintenance of traffic in accordance with the latest version of the Department s Design Standards index series 600 or an alternative plan signed and sealed by a professional Engineer and attached with the permit. 6. All FDOT property shall be restored to its original condition* Any damage to FDOT property as a result of this work shall be repaired and restored in a manner acceptable to the FDOT at the sole expense of the permittee. Special Provisions Conditions 1. In the event the permittee fails to meet any of the requirements of this permit by the FDOT the permitted activity must cease until brought into compliance. If compliance can not be met then the permit will be rendered void and said work shall be removed from the right of way at no cost to the FDOT. 2. Work shall commence within Work shall be completed by days of permit approval* 3. The rights and privileges herein set out are granted only to the extent of the State s right title and interest in the land to be entered upon and used by the permittee and the permittee will at all times and to the extent permitted by law assume all risk of and indemnify defend and save harmless the State of Florida and the FDOT 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 permittee of the aforesaid rights and privileges. Applicant I hereby agree to comply with all terms and conditions set forth and described in this permit. Attach any pertinent plans or drawings. 2. Attach notification letters sent to any Utilities both aerial and underground that will be potentially impacted* 3. The designated FDOT Engineer shall be notified 48 hours prior to beginning of work. at. Contact 4. All work materials and equipment shall be subject to inspection and approval by FDOT. .

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