STANTON COUNTY NEBRASKA HIGHWAY DEPARTMENT

APPLICATION FOR UNDERCROSSING COUNTY ROAD

or OCCUPYING COUNTY ROAD RIGHT-OF-WAY

 

 

With a ___________________________________________________________________ line.

(Water, Sewer, Irrigation, Drainage, etc.)

 

Date: _________________________

 

Application is hereby made to Stanton County by:

 

                                    Name: ______________________________________

                               Address:   ______________________________________

                                                ______________________________________

                            Telephone:  ______________________________________                               

 

 

To cross encroach upon County Road No. ______________ with a _____ Inch _________ Line

 

Name and Address of Contractor (if known) _________________________________________

____________________________________________________________________________

 

The applicant agrees to make this crossing or occupation in accordance with the terms and conditions of Stanton County.  Any permit which is issued due to this application becomes null and void if the work specified in the permit is not completed within six (6) months from the date of issuance of such permit or within any additional length of time that may be granted, due to written request by the applicant for an extension of time to complete the work.  Any extension of time will be granted in writing.  An applicant is liable for all damages to County Road and Right-of-Way, and shall backfill or otherwise return Right-of-Way to its original condition.

 

NOTE:  Two (2) sets of plans for the proposed work requested herein shall be submitted with this application.  The plans shall show the general features of the undercrossing and all information such as sizes, dimensions, and distances.  The application and plans should be submitted to Martha Detlefsen, Stanton County Clerk, PO Box 347, Stanton NE 68779; Telephone 402/439-2222, Fax 402/439-2200.

 

Notice shall be given to the Stanton County Clerk at least 24 hours before work is commenced.  No contractor shall perform work in a Right-of-Way without this permit in hand.

 

 

                                                                                    ___________________________________

                                                                                                                        Signature Applicant

 

Recommendations by County: ___________________________________________________

Highway Superintendent: _______________________________________________________

 

 

                                    Approved/Refused  c            __________________________________

                                                                                                Stanton County Commissioner

                                                                                                or Highway Superintendent

 

(revised 7-2007)