Application for Driveway Access Installation & Address Number This application is for new driveway access and address assignment on unincorporated county, township, and private roads only. For new access onto a state route call ODOT at 330-674-1906. An approved ODOT access permit along with this completed application is needed to receive a new address on all state routes. APPLICATION FEE: $55 Holmes County Engineer's Office P.O. Box 29 Millersburg, OH 44654 Fields A-D must be completed by applicant. VOID AFTER ONE YEARTo Be Filled Out By Applicant: (Check One)* Need Address Only. Access Location Known: Proceed with Application NO Access Location Known: This indicates that you want the Co. Eng. to inspect a parcel to ensure that a legal drive access location exists before transfer. Proceed with application. Landowner's Name*Landowner's Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Return form to owner via E-mail:*Select OneYesNoEmail* Location:Is this Driveway Existing or New?NewExistingTownship:Allotment:Lot Number:The driveway is located off:*State RouteCounty RoadTownship Road/HighwayPrivate RoadRoad/Highway Number:The driveway is located on which side of the road?*NorthSouthEastWestIs the proposed new driveway off an existing shared private drive?*NoYesIs an address needed for this location?*NoYesMeasurements to locate proposed driveway. Note: This location shall be measured from the center-line of the proposed driveway to the center-line of the nearest existing driveway with an address, or intersection of two roads. If you measure from an existing driveway on the opposite side of the road, do not include the width of the road in your measurement. Place a physical marker, such as a ribbon tied to a post, placed at the center of proposed access so the inspector can easily locate where you propose to place your driveway. Failure to do so may result in unnecessary delays in processing your application.Type of Structure*Single Family HomeDuplexApartmentCondoUtilityIndustrialPublic InstitutionCommercialOtherName of Commercial Structure*Information for "Other"*MapDrag the Red Marker On the Map to Location of the Requested Driveway AccessLocator ButtonAddressCoordinatesThe proposed driveway access is located how many feet from an existing driveway?*The proposed driveway access is located which direction from an existing driveway?*NorthSouthEastWestAddress of Existing Driveway Referred to:* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Procedure: 1. Owner, contractor, or surveyor fills out an application for a driveway access installation and returns to the Engineer’s Office with application fee. 2. The Engineer’s Office will inspect proposed driveway access location or access to proposed parcel and give recommendations according to the HOLMES COUNTY ACCESS MANAGEMENT REGULATIONS. 3. Upon preliminary approval of driveway access location, owner purchases required materials and completes all work necessary to install drive pipe as outlined on permit. The Engineer’s Office will forward the information to the GIS Office where an address, if needed, will be assigned and sent back to applicant. 4. A driveway permit must accompany any deed submitted for approval for a subdivision to the Holmes County Planning Commission. 5. After driveway access is constructed, the owner or contractor notifies Engineer’s Office that they are ready for final inspection. Permit: Applicants Statement: The applicant agrees to install or have installed a drive pipe of the type and size herein specified. The owner accepts full responsibility for the maintenance of this pipe forever. Failure to properly maintain this pipe shall void the owner’s permit. The applicant must notify the Holmes County Engineer’s Office at least 3 days in advance of starting the construction of the proposed driveway, so that a preliminary inspection can be scheduled. Failure to completely fill out application could result in unnecessary delays in processing your application. NOTE: Two working days prior to beginning any excavation, the Ohio Utilities Protection Service (OUPS) must be contacted in accordance with ORC Section 378.25 to 378.32. OUPS can be reached at 1-800-362-2764. The applicant is solely liable for any damages done as a consequence of building this driveway. Owner/agent certifies that he has a legal right, of record, to the aforementioned access for the property described in Section B hereinabove. Owner/agent agrees to indemnify and hold the Holmes County Engineer and the County of Holmes, their officers, agents and employees harmless from any and all claims that may arise as a result of owner/agents afore stated claim of access being defective, inadequate, or inaccurate. Signature*Date* Date Format: MM slash DD slash YYYY Special Notes: 1. Embed pipe in 3” or 4” of 304 gravel or limestone. 2. There shall be no large stones, blocks, curbing, or any other protruding obstruction, higher than the road surface at each end of the pipe. 3. Leave one foot at each end of pipe uncovered. Application Fee: $55 Checks Payable to: Holmes County Engineer This iframe contains the logic required to handle Ajax powered Gravity Forms.