The undersigned herewith make application for a permit to enter in upon and use a portion of the right-of-way of the Town of Camp Verde roads or dedicated streets for the purpose of installing a driveway and/or driveway culvert.

(parcel number and 9ll street address if known)

FOR AND IN THE CONSIDERATION of the granting of a permit for the purpose set forth herein the Permittee hereby agrees, covenants and binds said Permittee as follows, to-wit:

1. That the permittee assumes the responsibility and all liability for any injury or damage to said highway, or to any person while using said highway in a lawful manner, caused by or arising out of the exercise of this permit.

2. Maintenance of driveway and/or driveway culvert shall be the sole responsibility of the property owner and will in no way be responsibility of the Town of Camp Verde. All work shall be at the sole cost and expense of the permittee and shall be done a such time and in some manner as to be the least inconvenient to the traveling public. No driveway will be approved which causes a hazard to the traveling public.

3. If at any time hereafter the right-of-way, or any portion thereof, occupied and used by the permittee may be needed or required by the Permittee, application may be revoked by the Permitter and all right thereunder terminated and upon sufficient notice, the Permittee shall and will remove all property belonging to said Permittee.

4. All culverts shall be set at the apparent flow line of the ditch. No construction done under this permit shall alter the existing characteristics of the roadway and/or the drainage ditch without prior permission from the Town of Camp Verde Engineer's office.

5. Permit shall be in effect for thirty (30) days from the date issued.

6. MISCELLANEOUS -

1. Any and all work performed within a Town right-of-way and/or a Town maintained road shall require a permit from the Town of Camp Verde engineer's Office and shall be subject to whatever inspections that shall be deemed necessary by the Town Engineer.
2. The Permittee shall replace all signs moved or damaged during construction.
3. During the course of work, the Permittee shall maintain the work area in a clean and orderly condition. When a hazardous condition is created to the traveling public, barricades or proper warning devices should be used. Excess excavation, debris, etc., will not be permitted to accumulate on the road surface of shoulders. Work shall progress in such a manner that no condition such as soft trenches, drop-offs from the edge of the pavement, etc., will exist. Upon completion of installation, the Permittee shall clean the pavement surface, pull and dress shoulders, and otherwise put in order the entire work area covered by the permit to the satisfaction of the Town Engineer or his representative.

IN WITNESS WHEREOF this application has been duly signed this______day of ________,______.

Name (Please Print)__________________________________

Mailing Address__________________________________

__________________________________

Phone Number__________________________________

_____________________________________________

Signature of Applicant

¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶

THIS APPLICATION IS APPROVED WITH THE FOLLOWING REQUIREMENTS:

__________ NCR - No culvert is required at this time. However, if in the future this road is improved,

a culvert of the proper size will be required at the owner's expense.

__________" (inside diameter) CMP 16-gauge culvert required.

__________" (inside Diameter) CMP 16-gauge culvert or arch equivalent required.

¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶¶

______________________________________ _________________________________

Date Town of Camp Verde

COMMENTS:

Revised 7-22-96