Water and Sewer Facility Access Permit

2. Access to the District’s facilities will be allowed when in the public interest and approved by the District. A request for access shall be submitted to the SACWSD for approval before opening, entering, or disturbing the existing District-owned sewer collection system facilities.

4. Permittees are required to: •Complete the water and sewer facility access permit and receive approval from SACWSD •Notify the District of the times of entry •Comply with applicable confined space and traffic control rules and regulations •Allow access by a District inspector if requested •Provide any data obtained from entry activities (video, sampling results, etc.) There is no fee for a facility access permit. The permit is designed to keep the District informed of work on/near its lines and the public and workers safe.

6. Project Name *

7. Date of Application *
   Date of Application

8. Location of Work (include map)*

10. Start Date of Work*
    Start Date of Work

11. Completion date of work *
    Completion date of work

12. Contractors Email Address*

14. Description of Work including confined pace entry plan, traffic control plan, equipment used and procedures involved*

16. Contractors Name*

17. Contractors phone number*

18. Phone number of on-site personnel*

20. Address1*

21. City*

22. State

23. Zip*

25. Other Comments

29. For Internal use only

31. Approval

    1. Yes
    2. No

32. Comments

33. Approval Date
    Approval Date

Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field