2018-168B - Laserfiche WebLink

Home Browse Search

RULE 14-86.004, F.A.C. STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 850-04648 DRAINAGE CONNECTION PERMIT ROADWAY DESIGN 1oro6 Page 1 of 8 To be completed by DOT Drainage Connection Permit No. 2018-D-490-005 Received By One -Stop Permitting System State Road No. 60 Section No. 060 Milepost 28.100 Date 1/10/2018 Maintenance Unit 490 Work Program Project No. Construction Project No. Station Instructions for Drainage Connection Permit Pursuant to 14-86.004(6), F.A.C. "The Drainage Connection Permit form serves as the application. Once approved by the Department, the form and supporting documents become the Drainage Connection Permit." The applicant shall submit four completed permit packages with original signatures. Each package shall include all required attachments. All required signed and sealed plans and supporting documentation shall be submitted on no larger than (11" X 17") multipurpose paper, unless larger plan sheets are requested by the reviewer. The package will include the following items. If an item does not apply to your project, indicate "Not Applicable" or "N/A." Included Part Title Completed by: Special Instructions ✓ 1 Permit Information Sheet Applicant ✓ 2 Certification by a Licensed Professional Licensed Professional Signed and Sealed ✓ 3 Certification Applicant Signature ✓ 4 Owner's Authorization of a Representative Owner Signature ✓ 5 Affidavit of Ownership or Control and Statement of Contiguous Interest Owner Signature ✓ 6 Permit General Conditions FDOT ✓ 7 Permit Special Conditions FDOT ✓ 8 As -Built Certification Licensed Professional Signed and Sealed — Submit within 15 working days of completion of construction ✓ Attachment Legal Description ✓ Attachment Photographs of Existing Conditions ✓ Attachment Location Ma ✓ Attachment Grading Plan Licensed Professional Signed and Sealed ✓ Attachment Soil Borings ✓ Attachment Water Table / Percolation ✓ Attachment Calculations Attachment CD with Electronic Files of all Submittal Items Scanned Images in pdf format Note: Different Licensed Professionals may complete parts of the permit package. For example the Licensed Professional signing and sealing the as -built certification may be different from the Licensed Professional who signed and sealed the calculations for the permit package. EXCEPTIONS: Activities that qualify for an Exception are listed in Rule 14-86, F.A.C. A permit application to the Department is NOT required. However; if you desire verification whether the work qualifies for an exception, send a completed copy of this permit package with its requested information to the applicable FDOT District Office. , .ppro e 201,18-D-490-005 Georgi Celusnek 5/1/2018