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| Precinct ___________ |
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| GRANTEE: (Landowner)________________________________________ |
| MAILING ADDRESS: _______________________________________ |
| _______________________________________ |
| Daytime Contact #: ________________________________________ |
Dear Grantee:
The Washington County Road Department will set a culvert on the below mentioned property and hereby authorizes you to construct a driveway on the county right of way for development of access to your property in Washington County adjoining County Road: _____________________________ provided you agree to and comply with the following conditions;
All driveway pipes shall be corrugated Galvanized Metal Pipe of size and length determined by the County Road Administrator, and to be purchased by the Owner *. The purchase price should include delivery; THE COUNTY DOES NOT PICK UP CULVERTS.
Maintenance of driveway constructed hereunder shall be the responsibility of the grantee, and the Washington County Road Department reserves the right to require changes, maintenance or repairs as may be necessary to provide protection of life or property on or adjacent to the county road.
The grantee shall hold harmless Washington County and it's duly appointed agents and employees from any action for personal injury or property damage sustained in the installation of this driveway.
Washington County will set the culvert only ONCE! Any future changes necessary will be at the owners' expense, either by private contractor or county fee structure.
The Washington County Road Department will assist as follows: Install and back-fill culvert and place gravel over pipe out to the right of way line.
* When installing a culvert over 30' in length, the grantee does hereby accept full and total responsibility for keeping culvert clean and clear of any and all obstructions that would prevent the water from flowing freely. If the property where the culvert is placed transfers ownership, it is the grantees responsibility to advise the new owner of this agreement and have them sign a like agreement.
** Once concrete is placed over the culvert the maintenance of this culvert becomes the full and total responsibility of the grantee. The grantee must keep the culvert open and free flowing. If at any time the county must remove the culvert it will be the responsibility of the owner to replace the culvert.
This permit shall not be valid until grantee signs the statement in which he agrees to comply with the conditions herein.
I (we) the undersigned hereby agree to accept and comply with all the terms and conditions set out in this permit. |
| Signed:____________________________ |
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Witness:____________________________ |
| Date: _____________________________ |
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Date: ______________________________ |
| THIS SECTION FOR OFFICE USE ONLY: |
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| Diameter:____________________________(Inches) |
Minimum Length:_________________________(Feet) |
| WASHINGTON COUNTY ROAD DEPARTMENT |
| Date culvert set: ________________________________ |
County Road Administrator ____________ |
| Notes:________________________________________________________________________________________________________________________ |
| Area Staked: Y N Map: Y N Contact: Y N Concrete: Y N |
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Date: Purchased From:
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Washington County Road & Bridge Department
Permit To Construct Access Driveway on County Right of Way
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