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Cotlnty ]:it ~.-- ~,~: Cc. File No. Oate ' -' - ',: <br />Township ,',. L Div. File f~o. <br /> <br />Local Name :.:,,-'f ;:--.C,.,~ Subdivision !.',amc ~'C'.c' !. ,_.~..,' <br /> <br />Length ' ' ~idth :l ' Type ,.':. Condition <br /> <br />]s this a subdivision si:reeL subject to the consLr,~c~i]n require~t~entS FOr Such <br />streecs? ~. ,-. Recorded -F:L.: Book Page <br /> [s thcs a subdivisio~ ~:t subject to ~rticif, ation :~,~(noi' ~ ....... ~ <br />Number of homes having eo~rantes il;t0 road <br />Other uses having eHtraHces ~nto road ........ ~_L_: <br />goes right-of-way ob~aiP, ed n:aet present Div~sioH oF Hi.:}hwavs recuira;~,~Ht? . <br />If not, why? <br /> is petition (~i) a%~Tf~}T--~ <br />Is the County Co[r~ issiom,rs' 7~i'~a~--~'SR-Z) attac;~ed? - <br />If not, why? <br />Does the road mee[ presen~ minh;;um Oivision of tIignways constrHctio~i req~ire;~en~s? <br /> <br />]f not, state what is needed to place the read in an acceptable ~aintenance <br />condition under Remarks and Recommendations. <br />Is a map attached indicatirqi ioformation for reference in R~catin9 road by the <br />Planning Department? .. :' <br />Cost to place in acceptable maintenance condition: ToEal Cost S ~. ' <br />Grade, dra~n, stabilize S . '":' ~ Drainage $_... ~ , Other ~'.'.. '' <br /> <br />Remarks and Reco~nendations .-, .. .. . ~ ...-- <br /> <br />Reviewed and approYed <br />Board of Transportation .,qe,L, er <br /> <br />Reviewed and approved -'2/, - <br /> DIVISION ENGINE£R DiSFRICT E~GItlEER <br /> <br /> (I)o not write iH tbi~; space <br /> Fnr use oF Secondarx Roads P, ept. <br /> <br /> P(,~it'ion No.. ............... <br /> <br /> For use of Plannb,g Deo[.) <br /> <br /> <br />