Ground Disturbance Permit 
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  • EXCAVATION / GROUND DISTURBANCE PERMIT

    EXCAVATION / GROUND DISTURBANCE PERMIT

  • Start Date*
     - -
  • Permit Expires:
     - -
  • Format: (000) 000-0000.

  • UTILITIES PRESENT IN EXCAVATION AREA

  • SPECIAL PRECAUTIONS/REQUIREMENTS (check all that apply)*

  • COMPETENT PERSON CHECKLIST

  • SOIL CLASSIFICATION*
  • Have all procedural requirements been met and documented ?*
  • Is the excavation close to utilities, buildings, footings, pilings, source of vibration ?*
  • Have utilities, etc. been located (locates attached) ?*
  • Has a check for previous excavations in the area been made ?*
  • Have adequate supplies of equipment, PPE, shoring material, signs, barricades, machinery, etc. been assured and checked ?*

  • Other obstructions/hazards . Slope will be: Comments:      

  • Size of excavation

  • Do vehicular and machinery operation patterns need to be changed ?*
  • Will water removal operations/equipment be needed ?*
  • Have trench boxes or trench shields been checked ?*
  • Entrance/exit means (maximum travel distance to exit 25 ft.)*

  • Note: Every prefabricated, hydraulic or engineered support system shall be designed by a professional engineer. A copy of the drawing shall be provided to PCL.

  • Please use the dropdown list below to select the name of the PCL Approver and submit form for approval.

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  • Should be Empty: