Sophia Jones – Carbon County Utah

Class 1 Road Encroachment Application

Class 1 Road Application

Connection of residential driveways, parking areas, culverts or other structures affecting or altering the shoulder of the existing county roadway. Application Fee: $50.00 - Fee is not required if connected to an active New Home Building Permit.

Applicant Information

Building Permit Number (If Applicable):

Applicant Name/Property Owner(Required)

Name

Mail Address(Required)

Street Address Address Line 2 City State ZIP Code

Applicant Phone(Required)

Applicant Email(Required)

Company/Contractor Name (If Different than Applicant/Property Owner)

Company/Contractor Phone Number

Company/Contractor Email

Location and Timeframe

The location of the proposed encroachment is required. Either a physical address or exact GPS Coordinates are needed to process the application. If neither are provided, the application cannot be processed.

Location of Proposed Encroachment (Address)(Required)

Street Address Address Line 2 City State ZIP Code

Parcel #:

Location of Proposed Encroachment (GPS Coordinates)

Description of the proposed encroachment:(Required)

Dimensions of the proposed encroachment:(Required)

Backfill Material:(Required)

Start Date(Required)

End Date(Required)

Bond and Insurance Information

Bond Requirement Amount and Copy:

Copy of Bond:

Drop files here or

Max. file size: 200 MB.

Liability Insurance Company Name (If Applicable, Attach Copy of Policy)

Liability Policy

Drop files here or

Max. file size: 200 MB.

Once signed by the applicant and accepted by the road supervisor the applicant, is guaranteeing the completion of any improvements or construction proposed herein in conformance to the specifications contained in the application, and an agreement that upon failure to do so, the County or other competent contractor may complete the same to its satisfaction and charge the costs thereof to the Applicant.

Applicant Signature(Required)

Date:

The Supervisor shall confer with Planning and Zoning and other affected agencies during preliminary phases and shall review the application and shall within five (5) to ten (10) working days either grant the application or deny it. If he denies the application, he shall return it to the Applicant and set forth in writing attached thereto his reasons for doing so. The Applicant may submit an amended application at any time thereafter.

Carbon County Board/Committee Application

Application for board and committee positions in Carbon County.

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Date(Required)

Name(Required)

First Middle Initial Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Occupation(Required)

Employer(Required)

Area(s) of Expertise(Required)

Political Affiliation(Required)

U.S. Citizen?(Required)

Yes

Length of time you have resided in Carbon County (years):(Required)

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Class 1 Road Encroachment Application

Applicant Information

Location and Timeframe

Bond and Insurance Information

Carbon County Board/Committee Application

Class 2 Road Encroachment Application

Owner Information

Contractor Information

Contractor Emergency Contact Information

Testing Company Information

Location and Timeframe

Backfill Material Source

PERMIT FEE: $100.00

Acknowledgement – OFFICE USE ONLY – You can submit your application, thank you!

Volunteer Application

Emergency Contact Information

Driver's License Information

Volunteer Verifications

Acknowledgement and Signature

Volunteer Opportunities for Carbon County

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