Public Manhole Access Application

Name of Applicant Firm or Government Agency: *  

Purpose of the Request (Surveying, CCTV, COVID-19 Sampling, etc.): *  

Specific Performance Time Period.  (Access by the Applicant either before or after the stated time period shall constitute a violation of this Regional Wastewater Reclamation Department Directive).

Permit Activation Date: *          Time: *  9:00 AM - 3:30 PM6:00 PM - 6:00 AM

Permit Termination Date: * 

 Type 1 Access– Visual access of the public sanitary sewer system only.  (Physical entry into the public sanitary sewer system by employee of the applicant is not authorized).

 Type 2 Access– Non-Physical Access of the public sanitary sewer system to allow only the insertion and removal of tools or equipment below the rim of the manhole cover. No human body part may break the plane of the manhole cover rim. The tools or equipment to be inserted in the manhole are identified as follows:

Street Address: *   City: * 
(Address to the closest or most downstream manhole/structure being accessed. Please refer to the Pima County PimaMaps webpage.)

Closest Major Cross Streets: *  

Right of Way Access:  The Permitee is responsible for the jurisdiction’s Right of Way use permit, all traffic control and safety compliance measures necessary to protect the public and employees, and any other permits required to perform the work.

Permit Conditions

1. RWRD hereby notifies the applicant that sewer manholes are hazardous environments and may contain hazards such as low oxygen, explosive vapors and gases, high hydrogen sulfide, falls, pathogens, and hazardous energy.
2. Confined space entry is outside this process and requires specific RWRD approval.

By electronic submission of this permit application, I hereby certify that all of the information I have provided is true and correct, that I am duly authorized to submit this application on behalf of the permit applicant, and that the permit applicant will fully comply with all conditions of the permit.

*By(Name):  * Date: