HomeMy WebLinkAbout1986-003 Facility Permit - Oak StDIS TR IBUTION:
APPLICATION NO.
DATE
PERMIT NO.
White - Off~ce Yellow - AppTicant
JACKSON COUNTY
DEPARTMENT OF PUBLIC WORKS
APPLICATION FOR FACILITY PERMIT
Green - Inspector/Supervisor
PERMIT R~PE AND FEE COLLECTED:
Driveway/Road Approach
Road Encroachment
Road Improvement:
Major
Minor
Special
~ Utility
I, ~i~ ~.~.~'~ hereby make application for a facility
(Applicant's Name - Please Print)
permit upon the right-of-way of ~ ~ Milepost(s)
(Road Name - County Road Number)
in strict conformity to the exhibits attached hereto, subject to all terms, conditions, agreements,
stipulations, and provisions contained in the application and permit, and the rules and regulations
regarding roads and rights-of-way, as set forth by Jackson County Ordinance No. 'and the
Public Works Director's Permit Policy, and any other applicable regulations, law or ordinance.
DESCRIPTION OF FACILITY:
Signature' Mailing Address
(Phone where you can be reached) City
State Zip
(Applicant Do Not Write Below This Line)
FACILITY PERMIT
SPECIAL PROVISIONS: The terms and specifications which apply to this permit
are as shown on the attachment herewith and the permit conditions listed on
the reverse side of this application. Noncompliance with these terms,
specifications and conditions will result in cancellation of this permit.
ATTACHMENTS FOR:
Driveway/Road Approach
Road Encroachment
Road Improvement
Special
Utility
Other
ADDITIONAL REQUIREMENTS:
This permit shall be void unless the work herein contemplated shall have been completed before
INSPECTED:
Date [~ Approved ~ ~' ' [~ Approved
Issue Date
By [] Denied .... [] Denied
Director of Public Works
Permit No. 3256
1) This permit is granted for use only on roads under the
Jurisdiction of the Jackson County Board of Commissioners and is
not valid upon any federal highway, state highway, city or town
street, or any road not on the County road system of Jackson
County.
2) THE JACKSON COUNTY DEPARTMENT OF PUBLIC WORKS IS TO BE
NOTIFIED A MINIMUM OF 24 HOURS PRIOR TO STARTING WORK WITHIN A
COUNTY ROAD RIGHT-OF-WAY (776-7268 or 826-3122).
3) As provided in O.R.S. 758.010 the Public Works
Department, acting on behalf of the County Board of
Commissioners, may designate where utilities may be located
within a County road right-of-way and may order the location of
such facility changed if deemed expedient.
4) Permittee shall be responsible for all damages caused by
any operations associated with the utility installation. All
damaged areas shall be restored to an 'as good as, or better
than' condition as existed prior to the utility installation.
5) By acceptance of this permit, permittee agrees to be
responsible for all permit conditions, including the attached
special conditions, and said responsibility shall survive the
suspension or termination of this permit.
6) Utility permit applications must be accompanied by 2
sets of plans or a sketch that accurately depicts and locates
the work to be done so that someone unfamiliar with the work can
determine the location of the installation. Said plans must be
adhered to unless written permission to vary is granted by the
County Engineer.
Compliance with the applicable 'Special Conditions for
Underground Utilities Within County Road Rights-of-Way',
'Special Conditions for Underground Electric Power Line
Installation Within County Road Rights-of-Way' and/or 'Minimum
Signing Requirements for Construction and Maintenance Areas' is
required.
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SCALE I"= 50'
STREET
EDGE of A.C.._-.~. _
EXIST. 2" WATER LINE ~:~,~
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METER
& 314"
SERVICE
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