Applicant Information:

Application is hereby made to the Douglas County Engineer by:

* required fields

Project Information:

PROFILE DATED: To be provided by the county

TYPICAL SECTION*:


ADJACENT TO*:

AND STREET*:

The applicant agrees to cause the referenced subdivision, at its outside perimeter boundaries adjacent to dedicated public streets/county roads, to be graded to match the grade elevations of said streets/roads as set by the Douglas County Engineer.

As part of this application for certification, plan, profile, and cross section information, relating to the subdivision grading, shall be submitted to the Douglas County Engineer Office for review. The submitted information must include a location map with project station referenced, existing cross section information that extends from center line of the adjacent street/road to the development perimeter, future improved street/road templates and other information as may be deemed necessary by the Douglas County Engineer. Elevation information must be referenced to the U.S.G.S. Datum.

The undersigned agrees to cause the proposed side grading, of the referenced subdivision, to be carried out in accordance with the above described informational submittals. The applicant further agrees to complete all grading work, covered by this certification, within * days months of the date of the issuance of this certification.

I agree all above is correct, and realize checking this box is a legal substitute for signing this form.