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<br />ATTACHMENT "C"
<br />
<br />STATE OF FLORIDA
<br />DEPARTMENT OF TRANSPORTATION
<br />SPECIAL PERMIT
<br />
<br />District Six
<br />6/95
<br />
<br />DATE:
<br />SECTION NO:
<br />COUNTY:
<br />STATE PROJECT NO. .
<br />
<br />(if applicable)
<br />
<br />PERMIT NO.:
<br />STATE ROAD NO.:
<br />MILEPOST FROM
<br />RECORD NO.:
<br />
<br />TO:
<br />
<br />APPLICANT:
<br />ADDRESS:
<br />CITY:
<br />TELEPHONE NO.:
<br />
<br />STATE:
<br />
<br />ZIP CODE
<br />
<br />Applicant requests permission from the State of Florida Department of Transportation, hereinafter called the Department, to construct, operate, and
<br />maintain the facility shown in the accompanying engineering as described here:
<br />
<br />Location of Construction, Street Name, and Nearest Intersection:
<br />
<br />1. Is the proposed work within the corporate limits of a municipality: Yes ( ) No ( )
<br />Name of municipality: Local Government Contact:
<br />2. Prior to filing this application, the location of all existing utilities, both aerial and underground, has been ascertained, and the accurate
<br />locations are shown on the drawings (as applicable). A letter of notification was mailed on to the following
<br />util ities/munici pal iti es:
<br />
<br />3. It is expressly stipulated that this permit is a license for permissive use only and that the construction within and/or upon public property
<br />pursuant to this permit shall not operate to create or vest any property right in said holder.
<br />4. Whenever it is determined by the Department that it is necessary for the construction, repair, improvement, maintenance, safe and/or
<br />efficient operation, alteration, or relocation of any or all portion of said highway and/or transportation facility; the Permittee shall immediately
<br />remove any and all installed facilities from said highway and/or transportation facility, or reset or relocate thereon as required by the
<br />Department at the Permittee's expense.
<br />5. All work shall meet Department's Roadway and Traffic Desion Standards, Specifications for Road and Sridoe Construction, and other
<br />applicable criteria in effect at the time of permit issuance. The work shall be performed under the inspection supervision of
<br />, Permit/Maintenance Engineer located at , Telephone No
<br />This designated engineer shall be notified forty-eight (48) hours prior to the pre-construction meeting
<br />and again immediately before commencement of work. All material and equipment shall be subject to inspection by the designated engineer
<br />or his authorized representative.
<br />6. All Department property shall be restored to its original condition as far as practical in keeping with Department Specifications, and in a
<br />manner satisfactory to the Department, within thirty (30) days of the installation of the permitted work, unless otherwise approved by the
<br />Department:
<br />7. A drawing covering details of this work shall be made a part of this permit: This drawing shall inClude plan, profile, and cross sections as
<br />appropriate, and may be required to bear the seal of a professional engineer licensed in the State of Florida As built drawings are required:
<br />Yes ( ) No ( )
<br />8. The Permittee shall commence actual construction in good faith within days from the date of said permit approval and shall
<br />compete construction within days from the commencement of work unless the permittee shows good cause for delay and the
<br />Department approves an extension. No extension beyond one (1) year from the date of issuance of this permit will be granted.
<br />9. This construction and maintenance shall not interfere with the property and rights of a prior Permittee.
<br />10. Special Conditions and Instructions by the Department:
<br />
<br />11.
<br />
<br />It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the State's right, title, and interest in
<br />the land to be entered upon and used by the Permittee, his heirs, assigns, and successors in interest, and the Permittee will, at all times,
<br />assume all risk of and indemnify, defend, and save harmless the State of Florida and the Department from and against any and all loss,
<br />damage, cost, or expense arising in any manner on account of the exercise or attempted exercise by said Permittee of the aforesaid rights
<br />and privileges.
<br />During construction through Department acceptance of the permitted work, all safety regulations of the Department shall be observed and
<br />the holder must take measures, including placement and display of safety devices, that may be necessary in order to safely conduct the
<br />public through the project area in accordance with the Department's current edition of the Roadway and Traffic Desion Standards, Index
<br />Series 600, and the Manual of Uniform Traffic Control Devices.
<br />In case of non-compliance with the Department's requirements in effect as of the approved date of this permit, this permit is void and the
<br />work will be brought into compliance of'rem ved f m the right-of-way at no cost to the Department:
<br />
<br />/i~ " cO::drporat s~eal A:~'
<br />Signatur~ of Ptl,fQ'littf;e ~ __
<br />orman ~. ~aeLCUp,
<br />
<br />Name and Title (typed) Attested
<br />
<br />
<br />12.
<br />
<br />13.
<br />
<br />Submitted and Agreed to by:
<br />
<br />Recommended for approval:
<br />
<br />Title:
<br />
<br />Date:
<br />
<br />Approved by:
<br />District Permit Engineer or Authorized Representative
<br />
<br />Date:
<br />
<br />Contract Number: AP581
<br />Financial Project Number: 40339317801
<br />
<br />Page II of J I
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