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I' -'-vpe of Construction: __ Trench __ Bore __ Aerial __ Hole __ Chamber __ Plow <br /> <br />Construction Schedule: <br /> <br />Estimated Starting Date: <br /> <br />Estimated Ending Date: <br /> <br />Weekend Dates: <br /> <br />After Hour Dates: <br /> <br />List Streets that will be Blocked for Construction and Duration of Blockage: <br /> <br />Required Submittals for Permit: <br /> > Three sets of plans to scale <br /> <br /> > $5,000 Letter of Credit in favor of the City of Elk River <br /> <br /> > Name(s) and proof of Gopher State training (minimum one person per crew required). <br /> <br />Note: If a Facility is Hit: <br /> > Evacuate the area if a dangerous situation has been created <br /> ~ Call 911 on all facility hits <br /> <br /> > Call the utility you hit <br /> <br />Special Provision Required by the City of Elk River: <br /> <br /> A copy of this permit shall be present on the job sites whenever work is being conducted. <br /> <br />Applicant's Signature: <br /> <br />Date: <br /> <br />The applicant and/or its subcontractors, in carrying on any and all work accomplished under the permit <br />requested herein, agrees to conform strictly to the provisions of the City of Elk River Code of Ordinance <br />Section 1200 and applicable Minnesota State Statute, whether or not specified in the permit, together <br />with special provisions required by the City in the permit issued. Failure to adhere to these provisions is <br />grounds for revocation of the permit. <br /> <br />Authorizing City Official & Title <br /> <br />Date: <br /> <br /> <br />