ACCESS PERMIT APPLICATION
Any new or modied access areas onto a Town highway requires Town
approval. For access proposals on State roads, including RT 2 and RT 117, applicants are required to ap-
ply directly to VT Agency of Transportaon. For local approvals, please review secon 6.6 of the Public
Improvement Standards & Specicaons for the Town of Richmond (see municipal website) and provide
all the informaon requested in this applicaon. If you have quesons please contact the Highway De-
partment at 434-2631. Addional local permits and approvals may also be required, for informaon con-
tact the Zoning Administrave Ocer at 434-2430.
Permit #
Parcel ID: _____________
Applicaon Date: ______________ Physical Address of Property: _____________________________________________________
Applicant Name: ______________________________________
Applicant Mailing Address: ______________________________
____________________________________________________
____________________________________________________
Phone: ______________________________________________
Email: _______________________________________________
Property Owner Name: _________________________________
Owner Mailing Address: ________________________________
____________________________________________________
____________________________________________________
Phone: ______________________________________________
Email: _______________________________________________
Descripon of Project: ______________________________________________________Is property in oodplain? ______________
The Highway Department will review the proposal to ensure adequate sight lines, culverts and drainage issues. All new driveway cul-
verts must have a minimum diameter of 15”. Appropriate techniques such as headwalls and wingwalls may be required especially
where erosion or undermining may be expected to occur. The landowner is responsible for purchasing and installing all required ma-
terials as approved for installaon in the access permit. The landowner is responsible for all maintenance and repair for one year
from the date of compleon. For the replacement of exisng culverts, the Highway Department will make the decision that an ex-
isng culvert has failed. The landowner will pay for the purchase price of the culvert. If the grade of the driveway is altered by the
landowner so that the culvert is aected by frost acon, the landowner will be responsible for repairs.
Please include a Sketch Plan showing the proposed locaon of the new or modied access. (see reverse)
Town Highway Access Applicaon Fee—$115 residenal/ $145 commercial
Submit the completed applicaon form with the required fee to Planning & Zoning Oce.
TOWN CLERKS OFFICE Received for Record: __ _______ A.D. At __oclock _ _ minutes _ M
And Recorded in Book: page Aest:
Signatures: The undersigned hereby ceres this informaon to be complete and true.
Applicant Signature date Property Owner Signature date
- DO NOT WRITE BELOW THIS LINE—OFFICE USE ONLY—DO NOT WRITE BELOW THIS LINE—OFFICE USE ONLY—DO NOT WRITE BELOW THIS LINE—OFFICE USE ONLY —-
Applicaon received by ZAO & forwarded to Highway Department (date & inial): ______ Fee: _________________
Applicaon received & reviewed by Highway Department (date): Decision: APPROVED / DENIED / WITHDRAWN
Comments: ________ Addional comments on reverse
Highway Foreman Signature: Date: _________
Applicaon received by Town Manager and scheduled for Selectboard approval (date of SB meeng): ________________
Selectboard Decision: APPROVED / DENIED / WITHDRAWN Comments: ________
Selectboard Chair Signature: Date: ________
Return approved applicaon to Planning & Zoning Oce for applicant nocaon and ling (ZAO date & inial): _______
Applicaon created July 2017
click to sign
signature
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signature
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Sketch Plan: Please include a Sketch Plan showing the proposed locaon of the new or modied access, with accurate measurements
from the centerline of the proposed access (where it meet the town road) to any permanent mark. Please follow the specicaons and
proles from the current Public Improvement Standards & Specicaons for the Town of Richmond, including the culvert size (diameter
and length). Addional informaon may be required depending on the nature of the project.
Sketch Plan:
- DO NOT WRITE BELOW THIS LINE—OFFICE USE ONLY—DO NOT WRITE BELOW THIS LINE—OFFICE USE ONLY—DO NOT WRITE BELOW THIS LINE—OFFICE USE ONLY —-
Highway Department Comments: ________ ________
________ _______
________ _______
Is a post construcon inspecon required? YES / NO Reason for post construcon inspecon: ________
________ _______
________ _______
Fee required (insert amount): Fee collected (include amount and date received): ______________
Is an independent professional inspecon required? YES / NO Reason for independent professional inspecon: _______
________ _______
________ _______
Fee required (insert amount): Fee collected (include amount and date received): ______________
Highway Foreman Signature: Date: _________
Date of completed post construcon inspecon / independent professional inspecon: _____________________________________