Transcription of MATERIAL SOURCE APPROVAL REQUEST
1 MATERIAL SOURCE APPROVAL REQUEST north dakota department of transportation , Environmental and transportation Services SFN 58466 (8-2016)Complete a separate form for each MATERIAL SOURCE location. The following information is REQUIRED (including map file showing boundary of area to be SubmittedPit ID (NDDOT Use Only)Check One: New Existing Expansion of Existing SiteCheck One: Contractor Optioned department optionedLegal DescriptionCountySectionTownship NumberRangeSite Legal Location (quarter section)Approximate Depth of ExcavationSource NameMaterial/Activity (Check all that apply))
2 Aggregate Staging Area or Plant Site Borrow Stockpile Area Rock Pile/Rip-Rap Waste SiteProject InformationName (Project Engineer, Project Manager or NDDOT Tech SupportDivision/District/Consulting Engineering FirmProject Number or Project LocationProject Control NumberEmail AddressApplicantContact NameCompany NameTelephone NumberEmail AddressCommentsPlease allow at least 30 days for completion of this process. You MUST attach a map or the form will be returned to you! Print or save a copy for your own records!)
