ACCESS PERMIT APPLICATION
Any new or modied 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 Transportaon. For local approvals, please review secon 6.6 of the Public
Improvement Standards & Specicaons for the Town of Richmond (see municipal website) and provide
all the informaon requested in this applicaon. If you have quesons please contact the Highway De-
partment at 434-2631. Addional local permits and approvals may also be required, for informaon con-
tact the Zoning Administrave Ocer at 434-2430.
Permit #
Parcel ID: _____________
Applicaon Date: ______________ Physical Address of Property: _____________________________________________________
Applicant Name: ______________________________________
Applicant Mailing Address: ______________________________
____________________________________________________
____________________________________________________
Phone: ______________________________________________
Email: _______________________________________________
Property Owner Name: _________________________________
Owner Mailing Address: ________________________________
____________________________________________________
____________________________________________________
Phone: ______________________________________________
Email: _______________________________________________
Descripon 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 installaon in the access permit. The landowner is responsible for all maintenance and repair for one year
from the date of compleon. For the replacement of exisng culverts, the Highway Department will make the decision that an ex-
isng 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 aected by frost acon, the landowner will be responsible for repairs.
□ Please include a Sketch Plan showing the proposed locaon of the new or modied access. (see reverse)
□ Town Highway Access Applicaon Fee—$115 residenal/ $145 commercial
Submit the completed applicaon form with the required fee to Planning & Zoning Oce.
TOWN CLERK’S OFFICE Received for Record: __ _______ A.D. At __o’clock _ _ minutes _ M
And Recorded in Book: page Aest:
Signatures: The undersigned hereby ceres this informaon 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 —-
Applicaon received by ZAO & forwarded to Highway Department (date & inial): ______ Fee: _________________
Applicaon received & reviewed by Highway Department (date): Decision: APPROVED / DENIED / WITHDRAWN
Comments: ________ □ Addional comments on reverse
Highway Foreman Signature: Date: _________
Applicaon received by Town Manager and scheduled for Selectboard approval (date of SB meeng): ________________
Selectboard Decision: APPROVED / DENIED / WITHDRAWN Comments: ________
Selectboard Chair Signature: Date: ________
Return approved applicaon to Planning & Zoning Oce for applicant nocaon and ling (ZAO date & inial): _______
Applicaon created July 2017
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
