PORT SHELDON TOWNSHIP PRIVATE ROAD APPLICATION

Filing Fee $250.00

Name of Applicant______________________________________________________________

Mailing address:________________________________________________________________

________________________________________Phone Number_________________________

Permanent Parcel Number(s) of Property_____________________________________________

______________________________________________________________________________

Name(s) and Addresses of Other Persons or Parties with a Legal Interest in the Private Road or

Property_______________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Name of Proposed Private Road (spelling etc. exactly as approved by O.C.R.C.)

______________________________________________________________________________

Items to be submitted with application: (See Private Road Ordinance #41)

Site Plan

Road Plans and Lot Divisions

Proposed Deed Restrictions

Road Maintenance Agreement

Access Easement Agreement

Driveway Permit from Ottawa County Road Commission

No Duplication Letter (road name approval) from Ottawa County Road Commission

Township Liability: The owner(s) of the private road agree by applying for and securing a permit to construct the private road that they shall indemnify and save and hold the Township harmless from all claims for personal injury and/or property damage arising out of the failure to properly construct, maintain, repair, and replace the private road.

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Signature of Applicant Date

It is important that the applicant or a representative be present at the planning commission meeting when this application is considered.