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INSPECTOR COMMENTS: Rev 6/25 DALLAS COUNTY SECONDARY ROADS Phone: [PHONE REDACTED] Email: [EMAIL REDACTED] UTILITY PERMIT APPLICATION APPLICATION NO. CONTRACTOR PERMIT NO. Applicant agrees to comply with all stipulations of this document. Utility Name: Street Address: City: State: Zip Code: Contact Person: Contact Title: Contact Phone: Contact E-Mail: Completed By: Date: ASSIGNMENT COMMENTS: Inspector: Location: Date: Time: Contractor: Superintendent: Phone: For Dallas County Use Only APPROVED: Date County Engineer or Designated Representative Inspector Required Yes No Review Comments: ---PAGE BREAK--- 1. Location Plan. A completed location plan and construction prints shall be attached to this application. The location plan shall set forth the location with respect to the county road system and include a description of the proposed installation. It is the sole responsibility of the Applicant to determine the location of the Dallas County Road Right-of-Way. 2. Notice of Work. At least ten (10) working days prior to the proposed installation, an applicant shall file a completed Utility Permit Application stating the approximate date, location and nature of the proposed installation. Additionally, two working days prior to the actual work, the applicant and/or designated contractor shall notify the Road Department (Telephone # 515- 993-4289) of the intent to begin work. Any non-weather related cancellation or re-scheduling with less than 24 hours notice shall result in a 2 hour assessment at the applicable rate (re: Paragraph 4) to be paid to the Utility Inspector. 3. Inspection. A full-time inspector may be assigned to the work covered by this permit to insure compliance with the requirements herein. The inspector shall have the right to access, observe or test any work performed. 4. Remittance of Fees. The applicant shall pay wages and reimbursements directly to the Utility Inspector according to rates established by the Board of Supervisors: Payments shall be made within thirty (30) days after completion of the installation, or shall be subject to reasonable interest charges. 5. Issuance. The Utility Permit shall be completed by the utility company and not by the contractor. The permit shall be reviewed and issued by the Road Department - the Board of Supervisors, by resolution, has delegated full approval responsibilities to that department. 6. Requirements. A) Depth - Minimum depth of cover shall be as follows: Communications………….36" Electric……………….48" Water Se or Drainage Tile……………..24" B) The applicant shall use reference markers within the right of way to locate line and changes in alignment, as well as tile line locations. A permanent warning tape shall be placed one foot above all underground utility lines. C) Residents along the utility route shall have uninterrupted access to the public roads. D) The applicant and Road Department representative shall make a joint assessment of the road surfacing before and after construction. The applicant shall apply granular surfacing to restore the road to original condition. Any disturbed areas within the right-of-way shall be restored to original condition. Re-construction work that is performed by the County will be assessed to the applicant. E) Utility lines having an inside diameter of more than 2" which cross beneath a paved roadway shall be placed within approved casings. Cable casings may be placed through the sub-grade by directional boring or other approved methods. The casings shall extend to the toe of the fore slope on each side of the roadway. F) Any excavation, trenching or plowing within the right-of-way from November 15 – March 15 may cause excessive disturbance and therefore will be reviewed on a case-by-case basis. Depending upon the weather, approval may be suspended. G) Overhead utilities shall be located two feet inside the R.O.W. line. Vertical clearance over roadways shall be a minimum of twenty (20) feet measured at the centerline of the roadway. Any overhang problems with cross-arms must be addressed by the utility. H) Construction signing shall comply with the Manual of Uniform Traffic Control Devices. All work shall conform to the Iowa Department of Transportation Construction Manual, Statewide Urban Design Standards (SUDAS), AASHTO Roadside Design Guide, and criteria set forth therein. I) All equipment shall be removed from the right-of-way between the hours of 30 minutes before sunset to 30 minutes after sunrise. ---PAGE BREAK--- 7. Non-conforming Work. The Inspector may halt installation at any time if the applicant's work does not meet the permit requirements. 8. Emergency Wor k. In emergency situations, work may be initiated by an applicant to protect the public health, safety and welfare without first obtaining a Utility Permit. However, the Road Department office shall be notified as soon as possible (515)993-4289, dcengineering@dallascountyiowa,gov. A permit must be obtained with seven days of initiation of the work. All emergency work shall be done in conformity with the provisions of this ordinance and shall be inspected as soon as possible for full compliance. 9. County In fraction. Violation of this permit is a county infraction under Iowa Code section 331.307, punishable by a civil penalty of $100 for each violation. Each day that a violation occurs or is permitted to exist by the applicant constitutes a separate offense. Operation without a permit may be subject to criminal prosecution. 10. Hold Harmless. Dallas County and the Utility Inspector shall be held harmless for any damages resulting from the applicant's operations. A copy of a certificate of insurance naming Dallas County and the Utility Inspector as additional insured for the permit work shall be filed in the Road Department office prior to installation. The minimum limits of liability under the insurance policy shall be $1,000,000. 11. Performance Bond. Upon request, the applicant shall file a performance bond with the Road Department for restoration of areas within the right-of-way. This bond shall be $2,000, or more depending on the scope of the project. 12. Permit R equired. No work shall commence unless the utility company has obtained a Utility Permit from the Road Department. All requirements shall apply unless specifically waived in writing by Dallas County prior to installation. The permit shall be at the project site at all times. 13. Relocation. This permit does not provide an easement to the applicant, its lessees, successors and/or assigns. It is understood by the applicant that Dallas County is not responsible for any utility damaged within the right-of-way during construction or maintenance activities. Subsequent roadway improvement projects that require relocation or removal of utility lines shall be accomplished at the applicant's expense and at no cost to Dallas County. ---PAGE BREAK--- Min. 20' R.O.W. Line R.O.W. Line 2' TYP. Communication Cable and other Underground Utilities 36" Electric Cable 48" Water and Sewer 60" Min. 60" All Utilities Bore Recieving Pit (Typ.) Backslope Area Foreslope Area Shoulder Area Overhead Utilty Notes: - Utilites shall be located as close to the R.O.W. as possible but no closer than 2' unless authorized by the County Engineer - No bore pits shall be permitted in the shoulders or foreslopes. - All bore locations shall be clearly dimensioned by referencing the centerline of a road, driveway or other highly visible landmark. All Utilities Utilities Requirements for all Dallas County Utility Installations 2' Typ. - minimum separation from power poles if present