HomeMy WebLinkAboutAccess Connection - RAP Application - 9/26/2019 : A lication for Access Connection
For Department Use Only
Preapplication Conceptual View? Nonconforming Connection? Variance?
Category I -Minimum Connection Category II -Minor Connection
Field(agricultural),forest lands,utility operation and $50.00 Less than 1,000 AWDVTE $1,000.00
maintenance 1,00o to 1,500 AWDVTE $1,500.00
For each residential dwelling unit(up to 10 units) $50.00
utilizing a single connection point Fee per additional connection point $250.04
Other,with 100 AWDVTE or less $500.00
Fee per additional connection point $50.00
Category III - Major Connection Category IV-Temporary Connection
11 1,500 to 2,500 AWDVTE $2,500.00 Base fee per connection $100.00
17 Over 2,500 AWDVTE $4,000.00
Fee per additional connection point $1,000.00
Includes Median Opening
Proposed Use
State
Highway Number Mile os County
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7 4 Section Township _sZ Range EM!
Fees in the amount of are paid herewith to defray the basic administrative expense incident to the processing of this
application according to WAG 468-51,RCW Chapter 47,50,and/or RCW Chapter 47.32,and amendments thereto. The applicant further promises
to pay addit,onalgrnountsas shall be billed,If any,in reimbursement of the actual costs of the Department
Fee Total: '';7—
The undersl ned submits said application and accepts the conditions as set forth.
Applicant,Owner(Print Full Name)
Checks or Money Orders are to be made payable to
Address "Washington State Department of Transportation"
C%' U �
city state r I Zip Code For Consultant Use Onl
Consulting Flan
Tale one ber
t�. O Address
Applicant orized Signature
nn City State Zip Code
P` t r Ty a Telephone Number
1 Consultants Representative
Title
Federai Tax ID No.or Soc.Sec. No.(Optional) Print or Type Name
Title
Dated this _ day of � -v-�'�—�
p ca on lar cess Corinec on-Page
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. Additional information R crate Sheets:q p
A. Access Connection Permit(access,'driveways, etc.):
1. Site plan t
n showing access location and development of site {AI except farm or private
residence).
2. Vehicle trip generation (For commercial and multiple residence).
3. Land use restrictions or stipulations, If any, and agency involved.
4. Drainage Plan (With calculations required).
requirement).
5. Landscape plan (If local agency
6. Current complete names, mailing addresses, and telephone numbers of the property
owner(s), the developer(s),the appicant,the transportation and legal consultants)
representing the applicant (if any), and the local government representative(s) responsible for
processing the development's approval.
Connection and roadway design documents for Category II and II permits shall bear the seal and signature of
a professional engineer, registered in accordance with RCW Chapter 18.43.
For Department Use Only
Engineer's 1 Supervisor's Report
Reviewed in the field this day of
Comments
Signature
Engineer I Supervisor
RAMPS-Application for Access connection.-Page 2
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