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APPLICATION TO OPEN RIGHT OF WAY
Application Is hereby made for a permit to open a Jefferson County right of way. Please describe the right
of w?y Involved, and the nature of your request, ie. utility installation, roadway construction, etc. (attach a
detailed drawing or map and a copy of the plat if applicable).
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Applicant Namej",-~\~o~ '-~,,~ ~"~N\.tL.~~.~' - \l.....f..\ \ w>\nc;~
Address: 47 So s. \)\~co\JOJA.i R~l ~1lIL\-v~~~~' ~~~"'6
Phone: !I~o-;~.;...z..7!S~
Signatur~,,~ ~~c,~ Date: \vc.Q.%\\"~
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PERMIT
SUBJECT TO THE TERMS AND CONDITIONS BELOW, PERMISSION IS HEREBY
GRANTED TO THE APPLICANT TO OPEN THE DESIGNA1'ED RIGHT OF WAY.
ApPLICABLE PROVISIONS ARE NOTED BY AN (X).
Applicant is authorized to construct a private access road to his or her property In
accordance with applicable standards for private roads. The right of way will be located and
staked by a licensed land surveyor at the expense of the apr>licant. The permit does not
prevent other property owners or the general public from using the access road, In the event
users of the road wish to have the road maintained by the county, the users shall. under the
Inspection of the County Engineer, improve the road to minimum county road standards or
they may form a road improvement district (RID) per RCW 35,88 to pay for the costs of
Improvements,
Applicant shall construct a roadway to county road standards. The right of way will be
located and staked by a licensed land surveyor at the expense of the ap~iicant. After
construction to county road standards, the new road will be maintained by the county.
SEE ATTACHED SPECIAL PROVISIONS OR MITIGATIVE MEASURES
RECOMMENDED FOR APPROVAL BY
APPROVED BY
Chairman, Board of County, Commissioners
Applicant agrees to perform the work In strict compliance with the terms and conditions set out herein and
any special provisions attached hereto.
DATE
DATE
DATE
Signature of Applicant
PERMIT EXPIRATION DATE
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