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PICKENS COUNTY PLANNING & DEVELOPMENT 1266 East Church Street, Suite 136, Jasper, GA 30143 Phone: [PHONE REDACTED] Email: [EMAIL REDACTED] Fax: [PHONE REDACTED] Date: Permit Expires Permit Expires in 6 months ACCESS / ENCROACHMENT APPLICATION (All Roads serving the Public) Applications for permits shall be made at least 72 hours prior to the time any activities are conducted on the public roads and/or right-of-ways of Pickens County. Name: Phone: Email: Mailing Address: Directions to property with brief description of encroachment, together with the color of flagging to be used for marking drive. Stakes and flagging shall be placed within 48 hours after application. If location is not marked at time of inspection, a re-inspection fee will be charged to reevaluate. Please submit a copy of the property plat illustrating location of access/encroachment point along with draining information. There can be no deviation in the illustrated/flagged location (Culvert size if necessary). Applicant hereby acknowledges the opportunity to review the Pickens County Encroachment on Public Roads Ordinance, Sec. 54: 31-34, and fully understands the requirements and conditions. Minimum culvert pipe size is 18-inch diameter by 20 feet long. The pipe shall be “Corrugated Metal Pipe, or “Double Wall HDPE Pipe” or other D.O.T. approved materials. The driveway must be paved (either brick pavers, asphalt or concrete), from the edge of the road to 1 foot past our established Road Right-of-Way. THE APPLICANT SHALL INDEMNIFY AND HOLD HARMLESS PICKENS COUNTY FROM ANY CLAIM, SUIT, DAMAGE OR LEGAL ACTION FOR DAMAGES TO ANY THIRD PARTY AS A RESULT OF THE WORK PERFORMED UNDER SAID PERMIT. PICKENS COUNTY SHALL NOT BE RESPONSIBLE, FINANCIALLY OR OTHERWISE, FOR FUTURE RELOCATION COSTS IN THE EVENT OF FUTURE ROAD WIDENING OR UPGRADES, AND THE APPLICANT HAS NO VESTED RIGHT TO PERMANENT LOCATION OF THE LAND DISTURBING ACTIVITY REGULATED HEREIN. The signature of the property owner below indicates their agreement to abide by all Pickens County Land Development Standards if the Access/Encroachment Permit is issued. The owner shall email [EMAIL REDACTED] or call 706- 253-8873 or 8639 when the project is completed for final inspection. Signature: Date: APPROVED: DENIED: Road Name: Parcel Flagging Color Access/Encroach Permit Building Permit