1. PROPOSED BRIDGE
      2. OVER THE
      3. NAME OF STREAM
      4. AT OR NEAR
      5. TOWN, TOWNSHIP & COUNTY

“I ___________________________________(Name)
do hereby certify pursuant to the penalties of 18 Pa. C.S.A. Sec.
4904 to the best of my knowledge, information and belief, that the
information contained in the accompanying plans, specifications
and reports has been prepared in accordance with accepted
engineering practice, is true and correct, and is in conformance
with Chapter 105 of the rules and regulations of the Department of
Environmental Protection”
NOTE: Use of U.S.G.S. quadrangle map(s) is
recommended.
NOTES:
1. Existing and proposed 100-year flood
elevations must be shown.
2. If fill is used in bridge approaches, cross-
section must be extended to either side to
show the extent of the fill. Hydraulic
calculations must include effects of fill.
PROPOSED BRIDGE
OVER THE
NAME OF STREAM
AT OR NEAR
TOWN, TOWNSHIP & COUNTY
(If Required)
REGISTERED PROFESSIONAL
ENGINEER’S CERTIFICATION

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