HomeMy WebLinkAbout1971-043 Permit - COA - 1035 N Main
OREGONSTATE APPLICATION AND PERMIT TO HIGHWAY COMMISSION OCCUPY OR PERFORM
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OPERATIONS UPON A Permit Number:
Form
Form E-457 (Revised 7-891 STATE HIGHWAY
Name and Address of Applicant: Applicant hereby applies to the Oregon State Highway Commission for permission
to perform the following operations upon the right of way of the Rogue Valldy
City of Ashland at
City Hall Highway, No. -63, Jackson county, c c
Ashland, Oregon 97520 Ashland
and as shown on the
map or plan attached hereto and by this reference made a part hereof.
❑ Construct, operate and maintain a pole line. Highway Ref. Map No. 333_17
❑ Construct, operate and maintain a - buried cable. ❑ Erect and maintain a non-commercial sign.
Miscellaneous operations and/or
Construct, operate and maintain ar pipe line. facilities as described.
POLE LINE, BURIED CABLE OR PIPE LINE TO BE CONSTRUCTED ALONG OR ACROSS SAID HIGHWAY AT:
Mile Mile ENGINEERS Side of Hwy. or DISTANCE FROM BURIED CABLE OR PIPE Span
Post to Post Station to Station Angle of XING. Centerline R/W Line Depth Size and Kind Length
SIGN T BE. ERECTED ON SAID HIGHWAY AT:
Engineers Distance from Distance from Side of
Mile Post Station Highway Centerline Shoulder Highway Remarks
DESCRIPTION AND LOCATION OF MISCELLANEOUS OPERATIONS AND/OR FACILITIES
Construct and maintain a 4" concrete tile sewer lateral from house at 1035 North Main,
Station 80+50, M. P. 17.90. Connect to existing 61, concrete sewer pipe located in west
shoulder. See attached map.
Recommended for approval:
Dletrict Weer Divisio Engineer
This permit is issued by the Commission subject to the terms and provisions contained herein an or attached hereto; this permit
is accepted and approved by applicant subject to said terms and provisions.
Applicant: /J j - OREGON STATE HIGHWAY COMMISSION
By: r, e$np y E 'veer
~/ir .n t 1 ' C~.l4r'PS ~B/yL. , ~-LSLL
Date of Application: j htt i G 71 Effectiv /Date; 23-7/ P'ERMII$ OFFICE ENOINO
GENERAL PROVISIONS
The appropriate General Provisions contained .;in. "Oregon State Highway Commission,
GENERAL PROVISIONS, for Pole Line, Buried Cable, Pipe Line, Non-Commercial Signs, and
Miscellaneous Operations and/or Facility Permits, July, 1969," as supplemented and modified
by the following Special Provisions, shall apply to this permit, and by this reference are made a
part hereof. It shall be the obligation of the applicant to obtain said General Provisions from the
Commission and to deterrninii which of the 'various provisions are applicable before commencement
of work under said permit.
SPECIAL PROVISIONS..
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1. The'section of highway involved 1' 'snot" been designated as a'Freeway. '
2. The section of highway involvedx mmc/does not* require a permit from the United States
Forest Service.
3. General Provision V, A regarding insurance 3du&/shall not* apply during the initial in-
stallation of facilities.
4. General Provision V, B regarding bond ;bo&shall not* apply during the initial installa-
tion of-facilities. Bond in the amount of $ is required.
5. General Provision VI, H slgdt/shall not* apply to the following crossings of the highway:
a. ( ) All crossings covered by this permit.
b. ( ) Crossings as shown on the attached Exhibit Map. If applicable, trenching nearer
than feet from the toe of the fill slope or outer edge of surfacing will not
be permitted.
6. General Provision VI, H jdmd1/shall not* apply to the following crossings of intersecting
roads or streets, road approaches or driveways:
a. ( ) All such crossings covered by this permit.
b. ( ) Crossings as shown on the attached Exhibit Map. If applicable, trenching nearer
than feet from the toe of the fill slope or outer edges of the surfacing will
not be permitted.
7. Open cutting of the paved or surfaced portion of the highway under General Provision
VI, I)/is not* permited.
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