Application for Driveway or House Permit

Application for Driveway/House Number

HIGHLAND COUNTY
138 BOWERS AVE.,
P.O. BOX 297 HILLSBORO, OH 45133

Permit to work within and/or install facilities within the right of way limits of County and Township roads in Highland County.

Please Fill Out All Fields - This form is to apply for a house number and/or driveway permit.

Name of Applicant *

Street Address *

City *

State *

Zip Code *

Email Address *

Confirm Email Address *

Phone Number *

Exact Location of Work *

Road Name *

Township *

Today's Date *

Permit Type *

Parcel Number *

THE PERMIT HOLDER SHALL NOTIFY THE HIGHLAND COUNTY ENGINEER 2 WORKING DAYS IN ADVANCE OF COMMENCEMENT OF ANY WORK AT 1-937-393-3496 AND SHALL NOTIFY THE OHIO UTILITIES PROTECTION SERVICE 2 WORKING DAYS BEFORE DIGGING AT 1-800-362-2764.

The applicant agrees to the following conditions:
1. The traffic will be maintained by the use of; lights, signs, barricades, and if necessary flagmen for the protection of the public at all times unless the County Engineer grants written permission to close the road.
2. That disturbance to the road shoulder and road surface be kept at a minimum, that all trenches and excavations be backfilled with granular materials, properly compacted to preclude settlement, and that the work area shall be returned to as good or better than existing conditions.
3. That pavement cuts are prohibited unless specifically authorized in writing by the County Engineer.
4. That the Utilities Manual as published by the Ohio Department of Transportation shall be considered minimum standards of practice. Driveways shall meet the Highland County Driveways Standard.
5. That the permit holder shall assume responsibility for and shall hold Highland County harmless and defend any and all claims for personal injury and properly damages that might be brought as a result of this application or any work or activities performed by the permit holder pursuant to this permit, and further that Highland County will not be held responsible for any damage to facilities placed under this permit during the course of their normal maintenance and operations.
6. That all Driveways shall have the required minimum site distances as set forth in the Ohio Department of Transportation Location and Design Manual.
7. The terms of this permit shall remain in full force and effect until such time as the permitted installation is removed from public right of way.
8. Permit will expire one (1) year from the date of issue.

BY DIGITALLY SIGNING THIS FORM, YOU AGREE THAT YOU HAVE READ THE ABOVE CONDITIONS. THE ENCLOSED SPECIFICATIONS, AND INSTALLATION RECOMMENDATIONS AND I AGREE TO COMPLY. I UNDERSTAND THAT FAILURE TO DO SO MAY RESULT IN THIS PERMIT BEING REVOKED AND ANY CONSTRUCTION REMOVED FROM THE PUBLIC RIGHT-OF-WAY AT MY EXPENSE.

Signature *

Terms of Service *

By submitting this form, I agree with the terms of service.

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