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Peabo <br />L�lill ENERGY <br />EXCAVATION/CUT/DRILL PERMIT <br />TCCMPL CHECKS: <br />SERVICE CHECKS SIGNATURE <br />DATE <br />Electrical <br />2 I—L, I-zL <br />Telephone & Computer <br />�-- <br />�r <br />Raw Water <br />Potable Water <br />I <br />Sewer &Drainage , " ��.�. � =-•�_= <br />A/ <br />,� /� fW <br />Compressed Air_ <br />/ 1 <br />Environmental <br />General Comments: The location of the existing pipelines is <br />known and has been communicated to <br />the contractor. <br />The locations of the above mentioned services have been indicated by pegs where possible from the limited <br />information available. As exact depths may be inaccurate, EXCAVATE WITH CARE <br />Signed:_ <br />Date: <br />Mine Surveyor (For excavations) <br />APPROVAL BY RESPONSIBLE OFFICER: <br />This request is approved subject to compliance with the above and the documented permit conditions. <br />The permit lapses if no work is carried out within ten (10) days. In Such event, the contractor must seek <br />re -approval. <br />Signed: r <br />Date: / J� <br />�Sy Manage <br />Signed: <br />Date: /_ J <br />EI trical anger <br />Signed: - - - <br />Date: ' / `- J le <br />safety Manager <br />Signed:_ <br />Date:/-ALI /6 <br />' aintenanceOW&nager <br />Page 3 of 3 <br />