Fillable APPLICATION FOR ROAD NAME ASSIGNMENT (County of Otsego)

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APPLICATION FOR ROAD NAME ASSIGNMENT (County of Otsego)

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U.S.A. forms for County of Otsego

BROWSE COUNTY OF OTSEGO (MI) FORMS

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Otsego County Road Commission • P.O. BOX 537 • GAYLORD, MI 49734-0537 • (989) 732-5202
APPLICATION FOR ROAD NAME ASSIGNMENT
Date of Application: _______________________________________________
Applicant’s Name: _______________________________________________
Mailing Address: _______________________________________________
_______________________________________________
Phone Number: ( )
ROAD NAME REQUESTED: 1)_______________________________________
(list in order of preference)
2)_______________________________________
3)_______________________________________
Name of Intersecting Road: _______________________________________________
Location of Road: Township ________________________________ Section_____
Public __________ Private__________
NOTE: Applicant is responsible for obtaining the signatures of all individuals who own habitable
structures along the road to be named. Each of those individuals MUST sign below to indicate their
agreement with the name (attach additional page if necessary). EXCEPTION: If the road itself is
owned by one or more individuals, only those owners have a legal right to name that road…no other
signatures would be on this form. Return this form within 15 (fifteen) days of the “Date of Application”
above. Please sign & print names.
___________________________________ ____________________________________
___________________________________ ____________________________________
PLEASE ATTACH A BRIEF SKETCH OF ROAD LOCATION and INCLUDE DISTANCE
FROM NEAREST ROADS.
**********************************************************************
This portion to be filled out by Otsego County Road Commission Official:
Comments:___________________________________________________________________
____________________________________________________________________________
Signature of Official: __________________________________________________________
Date Approved: __________________________ Copies to: _____ Post Office
_____ Township Supervisor
_____ Equalization Dept.
_____ Requestor
_____ Otsego Lake Twp. Fire Chief
road name report.kmm • revised 10/03/03
Otsego County Road Commission • P. O. Box 537 • Gaylord, MI 49734-0537 • (989)732-5202
APPLICATION FOR PLACEMENT OF ROAD NAME SIGNS
PLEASE NOTE: When full payment has been made, the Road Commission will order and install the
sign(s). The cost is the responsibility of the Applicant.
Date of Application: ____________________ Cost:_____________________________
Applicants’s Name (print): __________________________________________________________
Mailing Address: __________________________________________________________
__________________________________________________________
Phone Number: _( )
__________________________________________________
Signature: __________________________________________________________
Road Name: __________________________________________________________
_____Public _____ Private
Location of Road: Township____________________________________ Section_____________
Brief sketch of road location and proposed sign location(s):
(Please include name of intersecting road and approximate distances to adjacent crossroads.)
Comments (O.C.R.C. Official):___________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Signature of O.C.R.C. Official:___________________________________________
Date Approved: ___________________________________________
 Sign Ordered: ___/___/___
 Copy to Applicant
 Copy to Sandy @ Equal.
road name report.kmm (revised 09/01/04)
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APPLICATION FOR ROAD NAME ASSIGNMENT (County of Otsego)

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Completed 18 July 2020

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