This application form is a quadruplicate copy, self-carbonized form. After Sections I and II are completed by the applicant, the first three
copies
(white, yellow and pink) should be submitted to the City of Winter Garden Engineering Department with proof of fee
issuance of a permit(*). All fees should be paid at the City Municipal Complex. The fourth copy (gold} should be retained by the
(white) becomes the approved permit, when Section Ill has been completed by the City of Winter Garden Engineering
Either the permit, or a copy thereof, must be available, at all times, at the worksite where the work is being preformed.
This application should be submitted electronically to the City of Winter Garden at the following address: engineering@cwgdn.com. All fees (if
required) should be paid at the City of W inter Garden Municipal Complex, 300 West Plant Street, Winter Garden, Florida, 34787 prior to
issuance of permit. The approved permit or a copy thereof is required to be available at the construction location when the work is being
performed.
The applicant is required to give the City of Winter Garden a minimum of 24 HOUR NOTICE PRIOR TO COMMENCEMENT OF WORK. Failure
to notify the City of Winter Garden in advance may result in immediate suspension of work.
INSTRUCTIONS AND CONDITIONS
THE ISSUANCE OF THIS PERMIT IS GOVERNED BY AND REGULATED BY THE FOLLOWING APPLICABLE DIRECTIVES:
Florida State Statutes
Chapter 77-153, Laws of Florida, Protection of Gas Pipelines
Orange County Code, Underground Utility Pipeline Contracting
Orange County Standards & Specifications for Sewerage & Water Facilities as Adopted and Modified by the City
Orange County Road Construction Specifications as Adopted and Modified by the City
Orange County, Right of Way Utilization Regulations as Adopted and Modified by the City
Regulations for the Transportation of Natural and Other Gas by Pipelines (Parts 191 and 192, Title 49 of the Code
of Federal Regulations)
AND ANY ADDITIONAL REQUIREMENTS OF THE CITY COMMISSION.
SECTION I GENERALINFORMATIONANDINSTRUCTIONS
To be completely filled out by all applicants.
Any work that commences without the required permits available on the job site shall be immediately suspended until such time as the
required permits have been acquired. A late charge for work commenced without a valid permit issued shall be charged in addition to the
normal permit fee. The late charge shall be as prescribed by the City Commission. Emergency work is excluded from late charges.
SECTION II CONDITIONS
It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right, title and interest in
the land to be entered upon and used by the permittee; and the permittee will at all times, assume all risk of and indemnify, defend, and save
harmless the City of W inter Garden from and against all loss, damage, cost or expense arising in any manner on the account of the exercise
or attempted exercise by said permittee of the aforesaid rights and privileges.
All permit applications will be reviewed by the Engineering Department and approvals or requests for additional information will be sent to the
applicant at the email address provided in this Section.
Applicant declares that prior to filing this permit, if the proposed work is within public right of way, he has ascertained the location of all
existing utilities, both aerial and underground. The specific names of the agencies that have been notified must be typed or printed in the
space provided, for the specific type utility. A gas ID number is required.
It is expressly stipulated that this permit is a license for permissive use only and that the placing of facilities upon public property pursuant to
this permit shall not operate to create or to vest any property right in said holder.
The construction and/or maintenance of a utility shall not interfere with the property and right or prior occupant.
Inthe event of widening, repair or reconstruction of a public road or highway, upon reasonable notice the permittee shall move its facilities
to clear such construction at no cost to the City of W inter Garden, insofar as such facilities are within the public right of way.
The holder of this permit shall take such safety measures, including the placing and display of caution signs and signals as are required by
the Manual on Uniform Traffic Control Devices for Streets and Highways, when working in public right of way, and shall also prevent any
obstructions or conditions which are or may become dangerous to the traveling public.
FEES will be computed in accordance with the schedule of fees adopted by the City Commission and are payable upon submission of
permit application.
SECTION Ill ENGINEERING DEPARTMENT USE ONLY
Applicant's additional requirements (if any); and expiration date; to be completed by the City of Winter Garden Engineering Department.
SECTION IV ENGINEERING DEPARTMENT USE ONLY
Completion Certificate - To be completed by the City of Winter Garden Engineering Inspector.
