Ditch Enclosure Permit FormDitch Enclosure Permit Form Owner Information Name * Phone * Fax Email Current Mailing Address * Current Mailing Address Current Mailing Address Current Mailing Address City City State/Province State/Province Zip/Postal Zip/PostalNew Mailing Address (if known) New Mailing Address (if known) New Mailing Address (if known) New Mailing Address (if known) City City State/Province State/Province Zip/Postal Zip/Postal Ditch Enclosure Contractor Contractor's Phone Location of Proposed / Existing Ditch Enclosure House# * Road# * Side of County Road Please SelectNorthSouthEastWest County Road# How many miles from county Road Which direction from the intersection with (State or County or Township) Road North South East West State County Township (State or County or Township) Road# Construction Start Date * Construction End Date * (60) days is normal limitIndemnification * I the undersigned, for his/her successors and assigns, covenants and agree to indemnify and save the County of Sandusky, Ohio harmless for any and all claims whatsoever arising out of the above work and/or existence of said encroachment; and further agrees that Sandusky County may revoke and terminate this permission to maintain an encroachment any time its' option; the undersigned further agrees to promptly restore said right of way to its original condition at such time as said encroachment is removed, and in the event said encroachment is removed to waive any and all claims for damages, including the repair and restoration of said right of way. Signature * signature keyboard Clear Signature of owner and person accepting all responsibility for ditch enclosure Date * Submit If you are human, leave this field blank. ΔDriveway PermitDriveway Permit Sandusky County Engineer's Driveway PermitOwner Information Name * Phone * Fax Email Current Mailing Address * Current Mailing Address Current Mailing Address Current Mailing Address City City State/Province State/Province Zip/Postal Zip/Postal Driveway Contractor Contractor's Phone Property Location House# * Road# * Project LocationExample: North side of County Road #20 West 600 feet East from the intersection with County Road # 57/Christy Road. _ Side of County Road# * Please selectNorthSouthEastWest County Road# * _ feet * _ from the intersection with * Please selectNorthSouthEastWest _ Road * Please selectStateCountyTownship Road# * Construction Start Date * Construction End Date * (60) days is normal limitUse and MaterialDriveway Use * Farm/Field Commercial Residential Industrial OtherOtherMaterial for Driveway Approach * Stone Asphalt OtherOtherIndemnification * I the undersigned, for his/her successors and assigns, covenants and agree to indemnify and save the County of Sandusky, Ohio harmless for any and all claims whatsoever arising out of the above work and/or existence of said encroachment; and further agrees that Sandusky County may revoke and terminate this permission to maintain an encroachment any time its' option; the undersigned further agrees to promptly restore said right of way to its original condition at such time as said encroachment is removed, and in the event said encroachment is removed to waive any and all claims for damages, including the repair and restoration of said right of way. Signature * signature keyboard Clear Signature of owner and person accepting all responsibility for driveway Date * Office Use Only This application is approved subject to the conditions listed below when signed by an authorized representative of the Sandusky County Engineer. Special Conditions: Please Check Mark NO culvert pipe is required as of the date signed below. However, the roadside must be sloped away from the road to insure that no ponding is created along the county highway. In the future, if a drainage problem arises that necessitates a culvert, the Owner will be required to install a culvert pipe at the Owner's expense. It is not the responsibility of the Sandusky County Engineer to install this culvert; however, it must be installed according to the Sandusky County Engineer's specifications. Signature signature keyboard Clear Date PLANNED SIZE OF CULVERT PIPE (IF NECESSARY): (MINIMUM INSIDE DIAMETER) Concrete is prohibited within __ feet from edge of pavement Submit If you are human, leave this field blank. ΔWork Within Right-of-Way Permit Permit FormWork Within Right-of-Way Permit Permit Form Owner Information Name * Phone * Fax Email Current Mailing Address * Current Mailing Address Current Mailing Address Current Mailing Address City City State/Province State/Province Zip/Postal Zip/PostalNew Mailing Address (if known) New Mailing Address (if known) New Mailing Address (if known) New Mailing Address (if known) City City State/Province State/Province Zip/Postal Zip/Postal Contractor Contractor's Phone Location of Proposed Work in Right of Way House# * Road# * Which side of County Road North South East West County Road# How many miles from county Road Which direction from the intersection with (State or County or Township) Road North South East West State County Township (State or County or Township) Road# Construction Start Date * Construction End Date * (60) days is normal limit Description of Proposed Work * Indemnification * I the undersigned, for his/her successors and assigns, covenants and agree to indemnify and save the County of Sandusky, Ohio harmless for any and all claims whatsoever arising out of the above work and/or existence of said encroachment; and further agrees that Sandusky County may revoke and terminate this permission to maintain an encroachment any time its' option; the undersigned further agrees to promptly restore said right of way to its original condition at such time as said encroachment is removed, and in the event said encroachment is removed to waive any and all claims for damages, including the repair and restoration of said right of way. Signature * signature keyboard Clear Signature of owner and person accepting all responsibility for work in right-of-way Date * Submit If you are human, leave this field blank. Δ
