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Home My WebLink AboutApplication APPLICANT 1/30/2008 (2) \' I~-' '~'~'-'''''~-:''".-.... L . ..... .,-~'" Oregon Depi1rtment of Transportation APPLICATION FOR STATE HIGHWAY APPROACH '.' ')::For{PFft'~~U,~~9NL y ", '; ~'"' . . .' '" .; , "'" "', -. ;,.':'-.:,:' ,",;.- '.,""', . '<. .~, . ....r "" . ~Da~e receive'd'~t:imp, ;"';"'i('.,ijc~M'r,~\Di,}:"> ,<~'" " . - !>' Required Information The applicant must submit the following information with the Application for State Highway Approach, ODOT will notitY the applicant if additional information is required, " . All attachments required by answers on the application form, including applicant signature, . If the applicant is not the owner of the property'to be served by the approach, then the property owner must authorize the applicant as a designated agen!, The applicant must have the property owner complete the Authorization of Designated Agent block on this,form OR submit a signed letter from the property owner authorizing the applicant as the designated agent. . Site plan and vicinity map approved or currently being reviewed by the local government. ' . A Land Use Compatibility Statement (LUCS) for a State Highway Approach (page 4 of this application) must be completed by the local government. ' . A copy of the current County tax lot map for the property served by the approach. Map must highlight all property that would be served by the approach and list all owner name(s) on adjacent properties, Make a note on map if ownership of adjacent property is same as subject property, Identify the location of the proposed approach on map, . A copy of the recorded easement(s), if the subject property has an existing easement(s) for access to the property, _' A copy of any existing state or local government approach permits for the property, In addition to the above submittals"the applicant may be required to place stakes or markings near the highway shoulder at the proposed appr~ach location. ' Definitions for commonly used,terms are in the attached brochure, The brochure is.also available on the ODOT website located at: httn:/lI/INfw.oreaon.oQviOOOT/HIJ\f'(f/:\CCESSMGTI . IApplic~~tl,Mq#.~~i9ii;.:;.">" I Last name: Salladay I Street address: 310 Fifth St. I City: Springfield I Mailing address: (same as above) City: IState: !ZIP: Phone: (541) 746-0637 IFax: (541) 746-0389 , E-mail: stacy@branchengineering.com Is applicant working as an agent of the owner? IgJ Yes 0 No If yes, the owner must complete the Authorization of Designated Agent sectiOn below, OR the applicant attach a letter from the owner authorizing the applicant to act as his/her agent. IApil~<i~?hrLi>.~a~()H';f"".-... ::'. ,.-;" ,.,., Highway name - May be a statewide highway name, such as Pacific Highway, or a local name, such as East Main Street. Route name - The posted highway number, such as 1"5 or US-84, . Highway name:, McKenzie Hwy ORE 126 Route number:, 015 Milepoinl: 6.62 Side of highW?y: IgJ North 0 South Is the highway in a national forest area? 0 Yes I2SI No '.''';.- _, .<t. '~.,.' " I County: I Cell/pager: ,', . ,.' ,:<-<1 I Company: Branch Engineering Inc] , ] 1 I I I I I County: Lane I First name: Stacy I State: OR IZIP: 97477 County: Lane O'East 0 West 734-2680.{9/07) Page 1 of4 PRE.SUBMITTAl RECIO JAN 3,0.2008 ... ___-1.. IAIJili9r@IO:I1-e:;:tlJ~~igilai~d:Age"t:::{,,:d;}:"'" ,'. I, Scott Leatham PR!NT NAME OF PROPERTY OWNER ,', ~, ,- .;,~ ,.., authorize "Stacy Salladay PRINT NAME OF APPUCANT to represent me in the m(7er of this ,hi9hW~y ,aPP:o,ach permit application, Owner signature: X j(7V/! (i,~ AP.R~~~!if~jg'~:~_t~r.~~~~~~'~~~!.~,:JZ,t~~~:~:'~: ?{'fe~,,~}~?\ ~:"i _~ I.. Date:! - / /"t3 ,';,,: ""f':'-' .:':,::" "'C' ;,' NOTIFICATION TO APPLICANT: The ODOT District Office will contact you wh.en your application has been reviewed, If additional documents are required to continue the application process you will be notified. When all of the necessarf documents have been received, the appliCation will be deemed complete. If your completed application is approved, preliminary construction specifications will be issued, A performance bond and liability insurance will be required before any construction work can begin on the highway right of way, For the complete rules regarding approach permitting, see OAR Chapter 734 Division 51, The Applicant declares, certifies, and affirms under penalty of applicabte state or federal laws that all information provided on this form and attachments are true and complete to the best of his/her knowledge, l';~~~~:_~~:;;'~t{a::':~~~'~ati~n-t;i~:;J;,;::ignature: X ~~~ dtv~k~..~ate:..r 1746. ,- " .1 EJ New Approach - There,is no existing permitted or grandfathered approach road at the location requested in this application, ' ' o Temporary Approach - The approach requested will be removed after a specified period of time. ~ Existing Approach - This application affects, or may affect, an exisiing approach. o Restricted Use Approach - The approach requested is for emergency services, govemment, utility access or similar specific uses with limited traffic, IVehiCleTurriiriij'Movements.;';t:if" ,.:'-{,.-":,, }',",,;; Tum movements requested: [2g All OR check all that apply: 0 Right 0 Right out 0 Left in 0 Left out ~r9P~ttY~:~~~tjrif9~~,~~~',\;~)j~\~~i.~.:;i~t,:;~.:: r:-;",i',t:.'~.i Last name: 'Leatham ' I First name: Scott I Street address: 2073 Musket St. ICity: Eugene I Mailing address: (same as above) I City: Phone: (541)912-1122 ~ ,," 'I I -I I Company: SumriierDevelopment I I I I .1 I .? " . . ,~ ." ,," I State: OR ,IZIP: 97408 I County: Lane State: I~IP: (541) 683-8586 I County: I Cell/pager: Fax: E-mail: Are there additional owners ofthe subject property? 0 Yes :~ No If Yes, attach the same contact information as above for each of the co-owners on a separate sheet R'r~p~~rWan!Q1ma;ti~<n],~~~~,~~.;~~F!4:'~"((~~iX.~,~,~~:~/:~~~i~~;.,'~'~ot:::~:}:~ {;~':'Y": ". ,< .; Subject property addressees): 6002 Main St. . City: Springfield jState: OR IZIP: 97478 ICounty: Lane !TownShiP(S)' IRange(S): ISectiOn(S): ITax lot(s): 17 ' 02. 34600 ICuITent zoning: Medium Density Residential (MDR) I Proposed zoning: Medium Density Res. (MDR) I'n the boxes below, describe theexisling and proposed land use(s) on the property, including square footage or acreage, Existing: Proposed: Currently, the site is developed with a single-family house. Square Feet: 29,366 Create a Medium Density Residential, 6-lot duplex subdivision. 734.2680 (9/07) Page 2 of 4 PRE.SUBMITTAL REC'O JAN 3 0 2008' ." ~.--=-_._...!.....- ; I I 'I I I I I I I o . ~!i~p.l~ri'~nd :Yi~irlity"M#p]"".i::(!;!li";;!;i::", ' ' If the local government has approved a site plan or is currently reviewing a plan for the proposed land use, then skip this ' page and attach a copy of those plans. Otherwise, draw and label a site plan indicating all applicable information listed below. You may use the space provided or another sheet no larger than 11" x 17", . Place arrow in box below to indicate direction of north for site sketch orientation, . Show distances related to access and on-site circulation, Include distance from property lines to the center of proposed approach, . Show all lots or parcels that are part of the property, and their corresponding tax lot number(s). . Using solid lines indicate proposed approaches, buildings, structures, equipment and other facilities: ' . Using dashed lines indicate existing approaches, buildings, structures, equipment and other facilities and easements, Note any existing Approach Road permits to the property. ' . Note nearest lar1dmark or cross street, and distance and direction from the requested approach location. . Show local streets abutting the property, the location-of the edge of pavement of the highway, and location and layout of parking areas showing connections to existing driveways, . Include location and distance measured from centerline of approach to nearest approach roads on both sides of the highway for at least 500 feet. Please indicate the width, land use category, and turning movements of all approaches, . Place an "X" across existing approaches to be closed. *See attached Site Plan (Existing Conditions and Site ,Assessment, Tentativ.e ,Subdivision; and Detail Sheet) currently in review. INl ,_I ""__~ . c , - '~-t . 734-2680 (9/07) Page 3 of 4 PRE-SUBMIlTAL RECIO, JAN 3 0 2008 ..---,:- --~ --.I