Utah Transit Authority

UTAH TRANSIT AUTHORITY

LICENSE APPLICATION

Utility Crossings / Minor General Property Use

As of 07-14-2014

A one time Administration Fee of $1,000 must be submitted with this application.

One time per application unless application has multiple locations.
Fee may increase for multiple locations.
Application will not be processed without this fee.
Fee subject to change without notice.

The customary time for UTA staff to review, approve, create and execute a minor property use or right-of-way “crossing” license agreement is approximately 8 weeks (from the day that an acceptable drawing is received). If this time frame does not meet the applicant’s needs, accommodations for expedited processing may be considered and granted for an additional fee of $2,500.

1. Name of Applicant:______

(Name to be shown on document)

NOTE: The corporate name of a company should be exactly as stated in its articles ofincorporation.

Business Address:______

*Invoicing Address:______

*Invoicing information needed by Applicant: ______

* Please provide the address to which invoicing for relevant fees or costs should be sent and describe information that is needed on all invoices to assure proper handling (such as file no., street location, type of crossing or encroachment, etc.)

Applicant is an:

Corporation What state? ______Type ______

Limited Liability CompanyWhat state? ______

Partnership What state? ______

Individual / Proprietorship

Other Explain ______

Business Entity Number: ______

Name and title of person who will execute the License Agreement for the Applicant.

______

(Name)(Title)

Contact person regarding preparation of the License Agreement.

Name: ______Title ______

Address: ______

Phone:______Mobile Phone ______

Fax:______E-mail ______

When do you propose to begin construction on UTA Property / Right-of-Way.

Proposed Start Date: ______Estimated Completion Date: ______

5. Is Proposed Use a (check all that apply): Crossing(perpendicular to Tracks)

Encroachment(parallel to Tracks)

Utility Surface, Type: ______

Other ______Overhead, Type: ______

______Underground, Type: ______

6. Is Proposed Use within a dedicated street(s)? No Yes

If yes, name of street(s): ______

7. Additional information pertinent to the Proposed Use:

8. Will construction be by a contractor? Yes No

By Applicant? Yes No

If contractor, name of contractor: ______

Address:______

Representative of contractor to contact in the event of questions.

______

(Name)(Phone #)(Fax #)

Estimate Cost of Construction:______
Measurement below lowest elevation of UTA corridor (Steel=8-10’ PVC ; HDPE= 11’+) or distance above top of highest UTA rail ( 23.5’ min Frontrunner, 10’ above Catenary on Trax lines)
Estimated Distance of Construction to UTA Track: ______
Will you be working within UTA ROW? Yes No
Estimated # of days you will be working within UTA ROW:______
Estimate # of days you will need a flagger:______
Will your Construction Crews be working on 8 or 12 hour shifts

Describe in detail the type of work, method and manner of installation on UTA Property:

17. Means to be taken to protect the UTA corridor and safety of workers and equipment during construction

Location of the Proposed Crossing(Note: If this is for an encroachment please include the beginning and ending Latitude/Longitude coordinates):

Latitude______Longitude ______

Approximate Street Address: ______

Submit application with administration fee, pertinent drawings, and a construction schedule to:

App: Utility Xing / Gen. Property UsePage 1 of 207-17-2014

UTAH TRANSIT AUTHORITY

Attn: Property Manager

669 West 200 South

Salt Lake City, Utah 84101

UTAH TRANSIT AUTHORITY

Attn: Property Manager

P.O. Box 30810

Salt Lake City, Utah 84130-0810

App: Utility Xing / Gen. Property UsePage 1 of 207-17-2014

Incomplete applications will not be reviewed. Please be sure to answer all questions and supply all necessary documents.

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