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During the construction of the approach(es), such barricades, signs and other traffic control devices shall be

erected and maintained by the permittee, as may be deemed necessary by the LHJ. Said devices shall conform

to the current issue of the Manual on Uniform Traffic Control Devices. Parked equipment and stored materials

shall be as far from the traveled way as feasible. Items stored within 30 feet of the traveled way shall be marked

and protected. The LHJ may provide barricades (when available) upon request.

In accepting this permit, the permittee, its successors and assigns, agrees to hold the LHJ harmless from any

liability caused by the installation, construction, maintenance or operation of the approach(es).

10.

If the work done under this permit interferes in any way with the drainage of the roadway, the permittee shall

wholly and at his own expense make such provision as the LHJ may direct to take care of said drainage problem.

11.

Upon completion of said work herein contemplated, all rubbish and debris shall be immediately removed and the

roadway and roadside shall be left neat and presentable and to the satisfaction of the LHJ.

12.

The permittee shall maintain at his or their sole expense the structure or object for which this permit is granted in

a condition satisfactory to the LHJ.

13.

Neither the acceptance of this permit nor anything herein contained shall be construed as a waiver by the

permittee or any rights given it by the constitution or laws of the State of Idaho or of the United States.

14.

No work shall be started until an authorized representative of the LHJ has given written notice to the permittee

to proceed, except in case of an emergency when verbal authorization may be given with a written permit and fee

required within five (5) working days.

THIS PERMIT SHALL NOT BE VALID FOR EXCAVATION UNTIL, OR UNLESS, THE

PROVISION OF IDAHO CODE, TITLE 55, CHAPTER 22, HAS BEEN COMPLIED WITH.

PRIOR TO EXCAVATION, CALL ONE NUMBER LOCATION SERVICE.

DIG LINE, INC. TELEPHONE NO. 1-800-342-1585

(initial)______

APPROACH MUST BE STAKED, FLAGGED, OR PAINTED PRIOR TO INSPECTION.

ATTACH SKETCH OF PROPOSED WORK AND TRAFFIC CONTROL PLANS.

COPY OF PERMIT MUST BE PRESENT AT WORK SITE DURING CONSTRUCTION.

(initial)______

I CERTIFY THAT I AM THE OWNER OR AUTHORIZED REPRESENTATIVE OF THE PROPOSED PROPERTY TO

BE SERVED, AND AGREE TO DO THE WORK REQUESTED HEREON IN ACCORDANCE WITH THE GENERAL

REQUIREMENTS LISTED ON THIS PERMIT. THE SPECIAL PROVISIONS AND THE PLANS MADE A PART

OF THIS PERMIT. TETON COUNTY ROAD & BRIDGE HAS 30 WORKING DAYS TO APPROVE THE PERMIT AND

THE PERMIT IS VALID FOR ONE (1) YEAR FROM DATE OF APPROVAL.

___________________________________________________________________________

OWNER/AUTHORIZED REPRESENTATIVE (Type or Print)

PHONE NO

___________________________________________________________________________________________

SIGNATURE OWNER/ AUTHORIZED REPRESENTATIVE

DATE

SUBJECT TO ALL TERMS, CONDITIONS, AND PROVISIONS SHOWN ON THIS FORM OR ATTACHMENTS, PERMISSION IS HEREBY

GRANTED TO THE ABOVE-NAMED APPLICANT TO PERFORM THE WORK DESCRIBED ABOVE

(For Local Highway Jurisdiction Use)

Sight Distance_______________

Approved ___ By ____________________ Date________

Final Inspection Date ________ By___________________

Not Approved___ By_________________ Correction required_______________________________________________

___________________________________________________________________________________________________

I agree to make all corrections described above by the date designated ________________________Date__________

(Applicant signature)

NO. OF APPROACHES @ $30.00____, @$60.00____ TOTAL______ CASH___ CHECK#______RECEIVED BY_______ DATE________

COPY MAILED TO PERMITTEE BY ____________ DATE _____________

COPY TO P & B ____ BY _________ DATE___________

Application And Permit To Work Within County Right Of Way Form - Teton County Road And Bridge Department Page 2

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