LLR # ____

/ CROSSING AGREEMENT
APPLICATION FORM

1-888-230-1111
OWNER/APPLICANT INFORMATION
DATE / Click here to enter a date. /
APPLICANT / Click here to enter text. /
CONTACT NAME / Click here to enter text. / Click here to enter text. /
First / Last
CONTACT DETAILS / Click here to enter text. / Click here to enter text. /
Phone / Email
MAILING ADDRESS OF APPLICANT / Click here to enter text. /
Street Address
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Town/City / Province / Postal Code
OWNER
(If different from Applicant) / Click here to enter text. /
CONTACT NAME / Click here to enter text. / Click here to enter text. /
First / Last
CONTACT DETAILS / Click here to enter text. / Click here to enter text. /
Phone / Email
MAILING ADDRESS OF OWNER / Click here to enter text. /
Street Address
Click here to enter text. / Click here to enter text. / Click here to enter text. /
Town/City / Province / Postal Code
LAND DESCRIPTION
LEGAL LAND DESCRIPTION / Choose an item. / Click here to enter text. / Click here to enter text. / Click here to enter text. / Choose an item. /
LSD or ¼ / Section / Township / Range / West of Meridian
Or
ADDRESS / Click here to enter text. / Click here to enter text. /
Street Address / Town/City
DESCRIPTION OF WORK
Please describe, in detail, the work you will be performing near the SaskWater facility.
Additionally, attach a drawing or drawings which clearly show the location of the crossing site in a regional context as well as details pertinent to the crossing, such as location of the work in relation to SaskWater’s pipeline, crossing angle, tie-in of crossing to road allowances, other legal land boundaries and right away limits. Failing to include a drawing will delay the Agreement process. / PROJECT START DATE / Click here to enter a date. /
Click here to enter text.
CROSSING AGREEMENTS
Please select all that apply. Agreements are valid for 1 year from date of issue.
NoENCROACHMENT
Agreement issued for any ground disturbance within 30 meters of the SaskWater pipeline or facility. / NoPIPELINE CROSSING
Agreement issued for any pipeline crossing a SaskWater pipeline or facility. If your pipeline is parallel to or approaching the SaskWater pipeline or facility, please see “ENCROACHMENT”.
Pipe Size: Click here to enter text.
(Outer Diameter, mm)
Pipe Material: Click here to enter text.
(e.g., PVC, Steel, etc.)
Product Carried: Click here to enter text.
(e.g., water, gas, etc.)
Depth of Pipeline (m): Click here to enter text.

NoSEISMIC ACTIVITY
Agreement issued for any seismic activity within 20 metres of the SaskWater pipeline.
NoCABLE CROSSING
Agreement issued for any underground or overhead lines crossing a SaskWater pipeline or facility. If parallel to or approaching the SaskWater pipeline or facility, please see “ENCROACHMENT”.
Please select one of the following:
Choose an item.
Type of Cable: Click here to enter text.
(e.g., telephone, power, etc.)
NoROAD CROSSING
Agreement issued for any temporary or permanent transportation over a SaskWater pipeline.
Is permanent Road Crossing required?
Choose an item.
Total Weight of Vehicle (kg): Click here to enter text.
(If you are using additional vehicles, please attach documentation for each)
# of Axles: Click here to enter text.

Individual Axle Weights (kg): Click here to enter text.

Tire Spacing (m): Click here to enter text.
NOTES/COMMENTS
Click here to enter text.
SaskWater will issue a Crossing Agreement for signature once the request has been approved. You must be approved prior to commencing work activity. The Crossing Agreement will stipulate any conditions required and list the SaskWater contact person for the crossing. You may be contacted for clarification of the information you provide on this form.
A SaskWater representative must be on site at all times during construction within 10 metres of the SaskWater pipeline and if the SaskWater pipeline is exposed by hydrovac.

September 2015SaskWater Crossing Agreement Application