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DOT 200: Application for Utility Permit (9/15)
South Dakota Department of Transportation, Office of Operations Support
700 E. Broadway Ave., Pierre, SD 57501-2586
Questions? See bottom of form for Area Engineer phone numbers.
I, the undersigned, request permission to construct and maintain a utility facility on public right of way at the above location and as shown on the attached layout sheet
and in accordance with provisions of Administrative Rules of South Dakota (ARSD) 70:04:05. In consideration for this permission,
I agree to abide by all conditions of said rules, and in addition, the following:
- This Utility Permit does not replace any other permit, license or other approval that may be required by any other entity holding
a property interest in the right of way, including but not limited to any tribal government, the Office of School and Public Lands, the U.S. Forest Service and the Bureau of Indian Affairs. The issuance of this Utility Permit does not relieve the applicant of the
obligation to obtain any other approvals that might be required for use of the highway right of way for utility purposes. The applicant is solely responsible for investigating whether additional approval is required and complying with any other applicable
requirements. If the applicant fails to secure all necessary approvals or comply with all applicable requirements, this permit is
of no effect whatsoever, and the South Dakota Department of Transportation (SDDOT) may, at the applicant’s sole expense, cause the immediate removal of the utility facilities.
- To furnish all materials, labor, incidentals and pay all costs involved with the construction and maintenance of the utility facility.
To perform approved open-cut trench operations in accordance with current SDDOT Open Cut Method of Utility Installation or
Repair, ARSD 70:04:05, Appendix A. To restore any damaged portions of the roadway and right of way to equal or better
conditions than existed prior to beginning work covered by the permit. To not install a utility over the top of any highway
drainage structure. To permanently mark above-ground pedestals/facilities with metal flags or markers located at least 48” above ground.
- If deemed necessary by the SDDOT, to move or alter the utility installation in any way due to maintenance or highway
construction within its present right-of-way width, the alteration will be accomplished by the owner without cost to the State.
- To provide protection to highway traffic during construction and maintenance by use of proper signs, barricades, flag persons and lights as prescribed in the current edition of the Manual on Uniform Traffic Control Devices.
- Workers are required to wear high-visibility safety apparel intended to provide conspicuity during both daytime and nighttime
usage, and meeting the Performance Class 2 or 3 requirements of the ANSI/SEA 107-2004 publication “American National Standard for High-Visibility Safety Apparel and Headwear.”
- To indemnify and hold the State of South Dakota, the SDDOT, its officers, agents and employees harmless, from and against
any and all actions, suits, damages, liability or other proceedings of any kind or nature brought because of any injuries or damage received or sustained by any person or property on account of the use or occupancy of highway right of way designated in this application.
Company
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By ____________________________________
Signature
TO BE COMPLETED BY THE SOUTH DAKOTA DEPARTMENT OF TRANSPORTATION
Project ______________________________________ Milepost _______________________________ Maintenance Unit __________
1. Prior to commencing construction and upon completion of work the applicant shall notify _____________________________
__________________________________ at ___________________________________. Phone ________________________
2. Special conditions _____________________________________________________________________________________________________
3. Failure to construct and maintain the utility facility in accordance with the provisions of this permit will automatically render this
permit null and void, and constitute grounds for its removal and/or full restoration of the site at the applicant’s expense.
Recommended ___________________________________ Date ____________ ___________________________________ Date ____________
City Representative Bridge/Road Design
Approved _______________________________________ Date ____________
Area Engineer
Approved _______________________________________ Date ____________
Region Engineer
This permit to construct and maintain a utility facility
is granted subject to all conditions as herein stated.