APPLICANT / PROPERTY OWNER CERTIFICATION:
This permit shall not be valid until Applicant signs the statement in which he/she agrees to comply
with conditions herein.
I, the undersigned, hereby agree to accept and comply with the terms set out in this permit for
construction of access driveway facilities on road right-of-way.
Should the Applicant/property owner elect to install a driveway improvement within the right-of-
way constructed of concrete pavement, brick or stone pavers, or other rigid material the Applicant/
property owner shall become solely responsible for the structure. Should removal of a portion or
entire driveway or mailbox become necessary for any reason deemed by Brazos County, the cost
of removal, and the cost for replacement, shall be the sole responsibility of the property owner.
I certify that I have read the Brazos County regulations and agree to abide by them.
I further acknowledge and agree that the obligations and duties contained herein shall be binding
on Property Owners, heirs, successors, and assigns.
Signature: __________________________ Printed Name:____________________________
STATE OF TEXAS
COUNTY OF BRAZOS
This instrument was acknowledged before me on ___________________________________ by
__________________________________________ NOTARY PUBLIC
Printed Name: ____________________________
My Commission Expires:____________________