Permit Number:
PO BOX 812
OROFINO, ID 83544
PHONE: (208) 476-4813
FAX : (208) 476-9553
E-MAIL:
CLEARWATER COUNTY
ROAD DEPARTMENT
ROB SIMON
Supervisor
APPLICATION AND PERMIT TO USE RIGHT OF WAY
General Information:Applicant Name: / Contact Number (s): Home and/or Work
Mailing Address: / City: / State: / Zip Code:
Email Address/Fax Number:
Property Owner Name (if different than applicant): / Contact Number (s):
Mailing Address: / City: / State: / Zip Code:
Site Information:
On the County Homepage www.clearwatercounty.org located under County Profile, click on the County Map to look up your parcel and tax information. Use the overlay Map Layers for determining zoning, floodplain, and platted subdivisions.
Property/Site Address: / City, State, Zip Code:
Ahsahka, ID 83520Elk River, ID 83827Kendrick, ID 83537Lenore, ID 83541Orofino, ID 83544Peck, ID 83545Pierce, ID 83546Weippe, ID 83553Not Sure
Parcel Identifier/Tax ID: / Directions to site:
Approaches:
Single Residence
Multiple Residence No. Served
Agriculture / *Attachments Required:
A Plan or Sketch of Proposed Work
Pictures of Site (Examples are Provided)
Other / Explain: Ahsahka, ID 83520Elk River, ID 83827Kendrick, ID 83537Lenore, ID 83541Orofino, ID 83544Peck, ID 83545Pierce, ID 83546Weippe, ID 83553Not Sure
Start Date: / Est. Completion Date:
I CERTIFY THAT I (the applicant) AM THE OWNER OR AUTHORIZED REPRESENTATIVE OF THE PROPOSED PROPERTY TO BE SERVED AND AGREE TO DO THE WORK REQUESTED HEREON IN ACCORDANCE WITH THE REQUIREMENTS PRINTED IN THE GENERAL PROVISIONS, THE SPECIAL PROVISIONS AND THE PLANS/ SKETCHES MADE A PART OF THIS PERMIT.
Applicant’s Name:(please print) / Title:
Applicant’s Signature: / Date:
NOTE APPLICATION PROCESS
1st Step: Applicant fills out his/her portion of the application and returns it to Clearwater County Road & Bridge.
2nd Step: A Clearwater County Representative goes to the site and does a preliminary inspection.
3rd Step: The Clearwater County Supervisor signs the Temporary Permit and provides a copy for the applicant.
4th Step: Once the Temporary Permit is in hand the applicant can begin work at the site, but not beforehand.
5th Step: After the project is finished the Clearwater County Representative will do a final inspection.
6th Step: If the applicant passes the final inspection the application will go before the Board of County Commissioners to be signed with a copy of the Final Permit returned to the applicant. The original documents will be stored by the Clearwater County Road & Bridge Department.
OFFICE USE ONLYDate Received by County: / Fee Amount: $200 N/A
Receipt No.
*Inspection Fee : $25 + Performance Bond Required: $175 = $200
Inspection Information:
Inspection Date: / Road Name: Ahsahka, ID 83520Elk River, ID 83827Kendrick, ID 83537Lenore, ID 83541Orofino, ID 83544Peck, ID 83545Pierce, ID 83546Weippe, ID 83553Not Sure / Road Number:
Mile Post: / Culvert Size: DIA LENGTH:
Width: / Posted Speed: MPH
Surface Type: / Estimated Vehicle Count (ADT):
Depth of Ditch: / Sight Distance: Left ft Right ft
TEMPORARY PERMIT
SIGNATURE: ______DATE: ______
LHJ Authorized Representative
TENTATIVE APPROVAL SUBJECT TO INSPECTION OF INSTALLATION PRIOR TO ISSUING FINAL PERMIT;
NOTICE: This work shall meet the requirements of the Local Highway Technical Assistance Council (LHTAC) Standard Approach Policy and 49-221 , Idaho Code. This permit shall not be valid for excavation until, or unless, the provision of Idaho Code Title 55, Chapter 22 have been complied with. PRIOR TO EXCAVATION, CALL LOCATION SERVICE Telephone No. 1-800-342-1585
GENERAL PROVISIONS
TERMS: 1. LOCAL HIGHWAY JURISDICTION - (LHJ) = CLEARWATER COUNTY
2. LOCAL HIGHWAY JURISDICTION REPRESENTATIVE = A Person Selected By The Board of County Commissioners to Represent the County.
3. MANUAL FOR USE OF PUBLIC RIGHT OF WAY = A Document Prepared by Local
Highway Technical Assistance Council and Adopted By Clearwater County Board of Commissioners
PROVISIONS:
1. A deposit in the amount to be determined by the Local Highway Jurisdiction (LHJ) (minimum $200.00 shall accompany this application). If proper construction or repair is made and accepted within ten (10) days, the deposit will be refunded. If proper construction or repair is not completed within ten days, the LHJ may make repairs and assess the deposit. A $25.00 administrative fee is non-refundable.
2. The LHJ may change, amend or terminate this permit or any of the conditions herein enumerated if permittee fails to comply with its provisions or requirements as set forth herein.
3. Approaches shall be for the bona fide purpose of securing access and not for the purpose of parking, conducting business or servicing vehicles on the public right-of-way.
4. No revisions or additions shall be made to an approach or its appurtenances on the public right-of-way without the written permission of the LHJ.
5. The permittee shall furnish all material, labor and equipment involved in the construction of the approach and its appurtenances. This shall include furnishing approved drainage pipe of a size specified on drainage detail and a part of this permit, curb and gutter, concrete sidewalk, etc., where required. Materials and workmanship shall be good quality and are subject to inspections and approval by the LHJ.
6. The LHJ reserves the right to require the permittee, its successors and assigns, at any time, to make such changes, additions, repairs and relocation's to any approach or its appurtenances within the public right-of-way as may be necessary to permit the relocation, reconstruction, widening, drainage, and maintenance of the roadway and/or to provide proper protection of life and property on or adjacent to the roadway.
7. Approaches shall conform to the plans made a part of this permit. Adequate drawings or sketches shall be included showing the design, materials, construction requirements and proposed location of the approach. All approaches shall be in accordance with Exhibits 9 and 13 in the Manual for Use of Public Right-of-Way - Standard Approach Policy.
8. In accepting this permit, the permittee, its successors and assigns, agrees to hold the LHJ, State of Idaho or its agents harmless from any liability caused by the installation, construction, maintenance or operation of the approach (es).
9. If the work done under this permit interferes in any way with the drainage of the roadway, the permittee shall wholly and at his own expense make such provisions as the LHJ may direct to take care of said drainage problem.
10. Upon completion of said work herein contemplated, all rubbish and debris shall be immediately removed and the roadway and the roadside shall be left neat and presentable and to the satisfaction of the LHJ
11. The permittee shall maintain at his or their sole expense the structure or object for which this permit is granted in a condition satisfactory to the LHJ.
12. This permit shall not be deemed or held to be an exclusive one and shall not prohibit the LHJ from granting other permits or franchise rights of like or other nature to other public or private utilities, nor shall it prevent the LHJ from using any of its roads,
streets, or public places or affect its right to full supervision and control over all or any part of them, none of which is hereby surrendered.
13. Neither the acceptance of this permit nor anything herein contained shall be construed as a waiver by the permittee of any rights given it by the constitution or laws of the State of Idaho or of the United States.
14. No work shall be started until an authorized representative of the LHJ has given written notice to the permittee to proceed, except in case of an emergency when verbal authorization may be given with a written permit and fee required within five (5) working days.
15. This permit shall be void unless the work herein contemplated shall have been completed before ______.
16. In accepting this permit the grantee, his successors and assigns, agree that any damage or injury done to the property of the grantee or any expense incurred by him through the operation of a contractor, working for the LHJ or any LHJ employee shall be at the expense of the grantee, his successors and assigns.
17. The undersigned hereby accept this permit subject to the terms and conditions as herein set forth.
(PAGE 3 & 4 GENERAL PROVISIONS)
BY: ______DATE: ______
SIGNATURE OF APPLICANT
:
SPECIAL PROVISIONS
1. This permit is issued for highway access only. Obtaining any other permits required by federal, state, or local agencies shall remain the responsibility of the permittee (i.e. water quality, cultural resources, wetlands, etc.)
2. Traffic control shall comply with the Manual on Uniform Traffic Control Devices for Streets and Highways. Copies are available for review at the County Road and Bridge Department or online at http://mutcd.fhwa.dot.gov . Office or at any Idaho Transportation Maintenance Station. Failure to Comply may result in the permit being revoked and possible civil penalties.
3. Permittee must have this Right-of-Way Use Permit in possession at all times while working within the
highway Right-of-Way. This permit shall available for inspection by COUNTY OFFICIALS and/or the Clearwater County Sheriffs Dept.
5. Upon completion of the construction, permittee shall immediately remove all debris and rubbish, the roadway and roadside shall be left neat and presentable and to the satisfaction of the LHJ.
6. The permittee is to control the vegetation and other sight obstructions on both sides of the approach to maintain the required sight distance.
7. Changes in ownership or further development of lands served by this approach will cause an automatic reevaluation of this approach permit
BY: ______DATE: ______
SIGNATURE OF APPLICANT
Permit Number:
PO BOX 812
OROFINO, ID 83544
PHONE: (208) 476-4813
FAX : (208) 476-9553
E-MAIL:
CLEARWATER COUNTY
ROAD DEPARTMENT
ROB SIMON
Supervisor
CLEARWATER COUNTY
Final Permit To Use Public Right - of- Way
THE BOARD OF COUNTY COMMISSIONERS, CLEARWATER COUNTY, STATE OF IDAHO:
GRANTS PERMISSION FOR THE USE OF PUBLIC RIGHT - OF - WAY ON AND ADJACENT TO THE COUNTY HIGHWAY STATED IN THE ATTACHED DOCUMENTS. THE PERMITTEE HAS COMPLIED WITH THE ATTACHED RULES, STANDARDS AND CONSTRUCTION SPECIFICATIONS SO STATED. ALL DOCUMENTS AND REFERENCES STATED IN THE ATTACHED TEMPORARY PERMIT NO. AS LISTED ABOVE, ARE A PART OF THIS PERMIT. ALL RULES AND REGULATIONS STATED ARE IN AFFECT UNLESS CHANGED OR MODIFIED IN WRITING OR THIS PERMIT IS TERMINATED OR CANCELED.
ROAD AND BRIDGE SUPERVISOR:
WORK HAS BEEN PERFORMED AS SPECIFIED IN APPLICATION TO USE RIGHT OF WAY AND ALL SPECIFICATIONS HAVE BEEN MET
SIGNATURE: ______DATE: ______
SUPERVISOR, Clearwater County R&B
PERMITTEE:
THE UNDERSIGNED HAVE READ THE PERMIT IN ITS ENTIRETY and AGREE TO ABIDE BY THE TERMS AS STATED:
SIGNATURE: ______DATE: ______
APPLICANT
CLEARWATER COUNTY:
SIGNATURE: ______DATE: ______
COUNTY COMMISSIONER
EXAMPLE 1: PLAN OF PROPOSED WORK
EXAMPLE 2: PICTURE OF SITE
Clearwater County ROW Encroachment Permit
1