And operate utility facilities adjacent to highway right-of-way




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TRANS 233 NOTIFICATION TO CONSTRUCT Wisconsin Department of Transportation

AND OPERATE UTILITY FACILITIES ADJACENT TO

HIGHWAY RIGHT-OF-WAY

DT1733 9/2005 (Trans. 220 WI Admin. Code)




Location Description – Quarter section, section, township, range, etc. To each copy of the application, attach one copy of the sketch showing location

     


Proposed Work Location

 Town  Village  City


of      
County

     


Applicant Name and Address

     


Anticipated Construction Starting Date

     
Applicant Work Order (If any)

     
Date of Trans. 233 Notification Submitted

     




Highway


Utility Facility/Work Type

Line Orientation













 STH      

 USH      

 Interstate      


 Electric  Gas/Petroleum

 Communications  Sanitary Sewer

 Water


 Overhead

 Underground




Note: The Wisconsin Department of Transportation (DOT) has a normal time of 30 days, but no less than 5 days, before any routine, minor utility erection or installation work commences, or less than 60 days before any major utility erection or installation work commences, to respond to the utility regarding the utility project. If the DOT’s response is not made within these time frames, this utility project is eligible for future compensation in accordance with the DOT’s utility reimbursement policy.


Name of Utility Person Responsible for Notification
     

Area Code - Telephone Number
     

The proposed utility installation, as identified above and shown on the attached drawings is not in conflict with the Six-Year Highway Improvement Program or Major Projects and is in compliance with the “Wisconsin Department of Transportation’s Utility Accommodation Policy”, current edition, and Wisconsin Administrative Code, Trans. 233. Future relocation is reimbursable to the utility in conformance with the Department’s utility reimbursement policy.


 Yes, this project is compatible with known DOT projects  No, a conflict exists

(For Wisconsin Department of Transportation) (Date)





(Title) (Area Code - Telephone Number)


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