Fillable Dp Dig Permit.xls (Southeastern Louisiana University)

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Dp Dig Permit.xls (Southeastern Louisiana University)

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Date Submitted:
Permit Number:
Date Expires:
Section One. Applicant Information
Section One. Applicant InformationSection One. Applicant Information
Section One. Applicant Information
Name of Applicant:
Position:
Company Represented: Email:
Mailing Address:
Phone:
Fax:
Section Two: Project Information
Section Two: Project InformationSection Two: Project Information
Section Two: Project Information
Project Name:
Location:
Contact:
Phone:
Reason for Excavation:
Anticipated Start Date: Anticipated Completion Date:
Excavating Equipment to be used:
Section Three: Marking Information
Section Three: Marking Information Section Three: Marking Information
Section Three: Marking Information
LA One Call
Date and Time Called: AM/PM Ticket #
LA One Call Marking Complete? (Yes/No) Yes No
Sketch area to be marked in space below. Include nearest roadways and/or landmarks
Faxed to Com:
Application for Excavation Permit
Application for Excavation PermitApplication for Excavation Permit
Application for Excavation Permit
To Be Completed by Applicant
Office of Physical Plant, Southeastern Louisiana University Revised 12/2008
Permit Number:
Work Order Number:
22/
26/
Section Four. Processing and Approval (To Be Completed by Physical Plant)
Section Four. Processing and Approval (To Be Completed by Physical Plant)Section Four. Processing and Approval (To Be Completed by Physical Plant)
Section Four. Processing and Approval (To Be Completed by Physical Plant)
Electrical Department Endorsement
Marked by ______________________________ on ________________
(Technician)
(Date)
Endorsed by ______________________________ on ________________
(Foreman)
(Date)
Additional concerns about excavating in proposed area:
Plumbing Department Endorsement
Marked by ______________________________ on ________________
(Technician)
(Date)
Endorsed by ______________________________ on ________________
(Foreman)
(Date)
Additional concerns about excavating in proposed area:
Grounds Department Endorsement
Marked by ______________________________ on ________________
(Technician)
(Date)
Endorsed by ______________________________ on ________________
(Foreman)
(Date)
Additional concerns about excavating in proposed area:
Basic Computing Services and Telephone Services Endorsement
Marked by ______________________________ on ________________
(Technician)
(Date)
Endorsed by ______________________________ on ________________
(Supervisor)
(Date)
Additional concerns about excavating in proposed area:
Permit Approval
Permit ApprovalPermit Approval
Permit Approval
The applicant may proceed with the proposed excavation. A copy of this approval must be kept onsite
throughout the excavation process. If the proposed excavation does not begin within seven days of the
Anticipated Start Date shown on this application, or the proposed excavation changes in size in any way, the
applicant must request a revised permit.
(Date)
(Construction Manager)
Office of Physical Plant, Southeastern Louisiana University Revised 12/2008
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Dp Dig Permit.xls (Southeastern Louisiana University)

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Completed 26 August 2020

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