Common use of Project Address Clause in Contracts

Project Address. Civil Township: Access To: (Street Name) Subdivision (If Applicable) , Section , Lot # Applicant: Property Owner: (if different than Applicant, indicate if same) Mailing Address Xxxxxxx Xxxxxxx Xxxx, Xxxxx, Xxx Xxxx, Xxxxx, Zip Phone: Phone: Email: Email PERMIT TYPE* Permit Type No. of Permits Permit Fee Permit Bond Required Field Entrance (only for access to agricultural field) @ $ 25 each = @ $ 0 Xxxxxxxxxxx Xxxxx @ $ 150 each = @ $ 0 Utility Pull-Off Drive (for unmanned utility facilities) @ $ 250 each = @ $ 10,000 per drive = Minor Commercial Drive (tapers only) @ $ 250 each = @ $ 10,000 per drive = Major Commercial Drive (w/tapers and auxiliary lanes) @ $ 250 each = @ $ 15,000 per drive = Public Road Approach/Private Road Approach @ $ 400 each = @ $ 15,000 each = Construction/Temporary Drive @ $ 100 each = @ $ 10,000 per drive = TOTAL PERMIT FEE = TOTAL PERMIT BOND = SUBMITTALS Purpose Submittals Required Submitted with Application Field Entrance or Residential Drive Layout sketch w/north arrow, basic dimensions, permit bond, and R/W conveyance documents Commercial or Utility Pull-Off Drive Scaled engineering drawings, permit bond, and R/W conveyance documents Lane Restriction for Construction Maintenance of Traffic Plan Construction/Temporary Drive Layout sketch w/ north arrow, basic dimensions, and permit bond SIGNATURE AND CERTIFICATION The undersigned certifies that they have the authority to make this application and bind Property Owner(s) and owner’s heirs to its terms, that the above information is true and correct, and that work requested by this application will be in conformance with the laws of Xxxxx County. I, and all persons performing the work authorized by this permit, have read, fully understand, and will abide by all requirements concerning the permit and construction requirements. The applicant and Property Owner agree and understand that Xxxxx County’s approval is limited to conveying its approval to install the approved traffic control devices only within its legal road right-of-ways. The applicant, the Property Owner of the traffic control devices being installed under this permit, and I understand that in the event Xxxxx County determines that any of the traffic control devices installed under this permit need to be repaired or maintained, relocated, or removed from the right-of-way, that the Property Owner or owner of the traffic control devices agrees to maintain, relocate or remove these facilities in a timely manner at no cost to Xxxxx County. _ Signature of Applicant Signature of Property Owner, if different than Applicant _ Printed Name Printed Name _ Date Date GENERAL PERMIT TERMS

Project Address. Civil Township: Access To: (Street Name) Subdivision (If Applicable) , Section , Lot # Applicant: Property Owner: (if different than Applicant, indicate if same) Mailing Address Xxxxxxx Xxxxxxx Xxxx, Xxxxx, Xxx Xxxx, Xxxxx, Zip Phone: Phone: Email: Email PERMIT TYPE* Permit Type No. of Permits Permit Fee Permit Bond Required Field Entrance (only for access to agricultural field) @ $ 25 each = @ $ 0 Xxxxxxxxxxx Xxxxx @ $ 150 each = @ $ 0 Utility Pull-Off Drive (for unmanned utility facilities) @ $ 250 each = @ $ 10,000 per drive = Minor Commercial Drive (tapers only) @ $ 250 each = @ $ 10,000 per drive = Major Commercial Drive (w/tapers and auxiliary lanes) @ $ 250 each = @ $ 15,000 25,000 per drive = Public Road Approach/Private Road Approach @ $ 400 500 each = @ $ 15,000 25,000 each = Construction/Temporary Drive @ $ 100 each = @ $ 10,000 per drive = TOTAL PERMIT FEE = TOTAL PERMIT BOND = SUBMITTALS Purpose Submittals Required Submitted with Application Field Entrance or Residential Drive Layout sketch w/north arrow, basic dimensions, permit bond, and R/W conveyance documents Commercial or Utility Pull-Off Drive Scaled engineering drawings, permit bond, and R/W conveyance documents Lane Restriction for Construction Maintenance of Traffic Plan Construction/Temporary Drive Layout sketch w/ north arrow, basic dimensions, and permit bond SIGNATURE AND CERTIFICATION The undersigned certifies that they have the authority to make this application and bind Property Owner(s) and owner’s heirs to its terms, that the above information is true and correct, and that work requested by this application will be in conformance with the laws of Xxxxx County. I, and all persons performing the work authorized by this permit, have read, fully understand, and will abide by all requirements concerning the permit and construction requirements. The applicant and Property Owner agree and understand that Xxxxx County’s approval is limited to conveying its approval to install the approved traffic control devices only within its legal road right-of-ways. The applicant, the Property Owner of the traffic control devices being installed under this permit, and I understand that in the event Xxxxx County determines that any of the traffic control devices installed under this permit need to be repaired or maintained, relocated, or removed from the right-of-way, that the Property Owner or owner of the traffic control devices agrees to maintain, relocate or remove these facilities in a timely manner at no cost to Xxxxx County. _ Signature of Applicant Signature of Property Owner, if different than Applicant _ Printed Name Printed Name _ Date Date GENERAL PERMIT TERMS