Application For Private Road Permit Form (Page 2 of 3) in pdf

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Plan and profile drawings and cross sections of the proposed improvements showing clearly all

materials, grades, and dimensions prepared by a Civil Engineer registered in the State of Michigan, and bearing

the seal of same.



A complete statement of all terms and conditions of use and maintenance of the proposed private road

including copies of all agreements or intended agreements providing for maintenance and improvements of the

private road. (See Section 12 of the Private Road Ordinance, Ord. No. 143).



Fees as established by the Township Board for the cost of inspections, plan review, project

administration and enforcement of this Ordinance.



The application shall be signed by the property owner or agent thereof. If signed by an agent it shall be

accompanied by a duly executed and notarized Power of Attorney providing express authority for the agent to

act on behalf of the owner and to bind the property in question, and shall represent that the applicant is making

the application on behalf of all persons having an interest in the private road or the abutting lots, and shall be

made under penalty of perjury.



A copy of any permits or applications for permits from the County Road Commission, County Water

Resources Commission, State Dept of Natural Resources, State Dept of Environmental Quality, etc., as required

by Section 7, of the Private Road Ordinance, Ord. No. 143, or any other agencies having jurisdiction or interest

in the property.



An agreement by the owner or person in charge of the proposed private road in a form approved by the

Township Board which requests and consents to enforcement of the Michigan Vehicle Code and the Township’s

Private Road Ordinance. The agreement shall provide for the placement of traffic signs and devices meeting the

requirements of the Michigan Manual of Uniform Traffic Control Devices. The owner or person in charge of the

private road shall be responsible for the cost of installing and for the continuous maintenance of traffic control

devices required under this section.

I hereby certify that the information provided herein is accurate to the best of my knowledge:

Signature of Applicant _________________________________________________ Date ___________________

Print Name

Application Fee $ _______________________________ Ck# _____________________ Date ________________

_____________________________________________________________________________________________

York Township Board Approval of Application _______________________________________________________

_____________________________________________________________________________________________

Receipt of required deposit, performance security and predetermined fees ________________________________

_____________________________________________________________________________________________

York Township Board Resolution approving the road permit: ____________________________________________

_____________________________________________________________________________________________

04-2014

Application For Private Road Permit Form Page 2