APPLICATION FOR PERMIT

CONSTRUCTING DRIVEWAYS, FIELD ENTRANCES, STREETS OR PUBLIC ROADS ON COUNTY RIGHT-OF-WAY APPLICATION

Applicants Information:

Application is hereby made to the Douglas County Engineer by:

* required fields

Project Information:

For construction of Field Entrance Driveway(s) Approach Road Public Road from the shoulder line or edge of pavement on the East West North South side of road * , and approximately * feet East West North South of * .

The applicant requests consideration to construct the connection(s) to a width of * feet and to surface the connection(s) with Concrete Asphalt Gravel or Rock Other .

An authorized representative of the Douglas County Engineer Office will determine the number and dimensions of any drainage structures required; and the applicant shall furnish, install or construct such structures at his own expense.

The applicant agrees to construct the connection(s) requested by this application in accordance with the terms and conditions set forth in this permit issued by the Douglas County Engineer within * days months from the date of issuance of such permit. Any permit which is issued due to this application becomes null and void if the work specified in the permit is not completed within the length of time requested in this application. Any extension of time must be requested and granted in writing.

Note: In the event future highway construction or maintenance requires an alteration, relocation or removal of the work authorized in this permit, Douglas County will have all rights to remove any structure, appurtenances or do any other acts of removal or reshaping in regard to the County Right-of-way. Applicant will not be entitled to damages for such revocation of the permit or the removal of the structures erected under this permit.

Clicking this box signifies acceptance that the above is true, and is being submitted in lieu of an actual signature.