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a , Rule 14-46.001 F.A.C. Florida Department of Transportation Dec 14,2016 Page 2 of 3 UTILITY PERMIT PERMIT NO: 2018-H-798-268 APPLICANT SIGNATURE By the below signature(s)the UAO and/or Utility Builder agree(s)to construct,operate,and maintain the work as noted in the above Work Description, shown in plans and incorporated documents.in compliance with the UAM.all instructions noted in the FDOT Special Instructions Box,and special instructions incorporated into this permit.The UAO and/or Utility Builder declares,the location of all existing utilities that it owns or has an interest in.both aerial and underground,are accurately shown on the plans of the work areas. In accordance with UAM Section 2.8.the UAO and/or Utility Builder further declares that a letter of notification was delivered to the owners of other facilities within the work areas and that those listed below are the only facility owners known to be involved or potentially impacted by the proposed work. Date Notified: Name of other facility owners(attach additional sheets if necessary). 8/2/2018 Charter Communications 8/2/2018 City of Zephyrhills 8/2/2018 Duke Energy 8/2/2018 Florida Governmental Utility Authority 8/2/2018 Frontier Communications 8/2/2018 Pasco County Traffic Operations 8/2/2018 Pasco County Utilities 8/2/2018 TECO 8/2/2018 WREC Utility Agency/Owner Utility Builder(when applicable) Signature:CHRISTOPHER URIA(digital Date:8/14/2018 Signature:N/A Date:N/A signature) Name(printed):CHRISTOPHER URIA Name(printed):NIA Title:Engineering Project Manager Title:N/A FDOT PROJECT INFORMATION Pursuant to UAM Section 2.1(10), the utility work is within FDOT projects listed below and must have a Utility Work Schedule for each project approved prior to commencement of work within the FDOT project limits: There are NO FDOT constructions(proposed or underway). This work is NOT related to an approved Utility Work Schedule. FDOT SPECIAL INSTRUCTIONS In accordance with UAM Section 2.7.FDOT incorporates the below and attached special instructions into this permit. Submit utility certification upon completion of the project. PERMIT APPROVAL By signature below,FDOT gives permission to the UAO and/or Utility Builder to construct,operate,and maintain the utilities indicated in this Utility Permit in compliance with the UAM,all incorporated documents,and special instructions.Any changes to the approved work must be approved by the FDOT's Approving Engineer and attached and incorporated into this permit in accordance with UAM Section 2.11. Approving Engineer:Douglas Crosby(digital signature) Date:8/16/2018 Name:Douglas Crosby Title:NIA Notification of Utility Work to be provide to Telephone (352)848-2600 or Email: timothy.glover@dot.state.fl.us An FDOT Representative is required to be present on the worksite prior to commencement of work.Yes 0 No 9 Rep.Name: N/A Telephone N/A Email: N/A §'." E