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PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 1 INSTRUCTIONS Fill out this application and the accompanying petition and mail, email or fax to: Pickens County Department of Public Works 3043 Camp Road Jasper GA 30143 Fax: (706) 253-8879 Email: [EMAIL REDACTED] REQUIRED INFORMATION Subdivision Name: Subdivision Contact Person: Name: Address: City, State, Zip: Tel: (Day) Fax: Email: Comments: (Continued on Page 2) ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 2 PETITION TO ACCOMPANY APPLICATION 1. We the undersigned, all being property owners of the subdivision legally titled hereby petition for the installation of speed humps on the following roadways: a. b. c. d. e. f. 2. Each of us does hereby acknowledge that he or she has read and fully understands the Subdivision Speed Hump Policy of Pickens County Georgia (“Speed Hump Policy”), which is contained in the Appendix beginning on Page 3. 3. Each of us does hereby acknowledge that the Public Works Department will not conduct scraping or other maintenance activities on roadways on which speed humps have been installed during periods of time in which inclement weather has resulted in roadway conditions impacted by frozen precipitation of any kind. This petition represents or more participation of the property owners of this subdivision desiring the installation of the speed humps on the above-noted roadways in accordance with the Speed Hump Policy, as set forth in Appendix A beginning on Page 3, and as is noted by the signatures of property owners on the on the Petition Signature Sheets, as are set forth in Appendix B beginning on Page 12. ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 3 APPENDIX A Pickens County Georgia Neighborhood Speed Hump Policy Pickens County Board of Commissioners 1266 East Church Street Jasper Georgia 30143 (706) 253 - 8809 ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 4 I. Purpose The paramount duty of the Pickens County Board of Commissioners is to protect the wellbeing of Pickens County residents and visitors. The purpose of the Pickens County’s Speed Hump Policy is to consider all relevant factors in determining the appropriate role of speed humps in optimizing the safe and efficient movement of traffic through applicable residential areas of the County. This policy statement sets forth the: 1. Criteria that govern the installation of speed humps on applicable roadways in response to citizen requests (See Section I) 2. Process whereby citizens can request the installation of speed humps as a traffic calming measure within an impacted area (See Section II) 3. Review process by which citizens’ requests for the installation of speed humps will be evaluated for approval or rejection (See Section III) 4. Process for the request of removal speed humps Pickens County’s Speed Hump Policy is applicable to roadways that are: 1. Within the county road system of Pickens County; 2. Within the unincorporated area of Pickens County; and 3. Whose primary function is to provide access to abutting residential properties, i.e., roadways in subdivisions. To qualify for installation of speed humps, all requirements set forth in this Policy must be met. ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 5 II. Speed Hump Criteria The following criteria to govern the installation of speed humps on Pickens County roadways in response to citizen requests: A. Roadway Type 1. Speed humps will only be installed on local roadways whose primary function is to provide access to abutting residential properties, i.e., roadways in subdivisions 2. Speed humps will not be installed in front of commercial property, on major collectors, or arterial roadways. B. Traffic Volume Speed humps will only be installed on roadways with traffic volumes of less than three-hundred-fifty (350) vehicles per day. C. Traffic Diversion Speed Humps will not be placed on a roadway if a traffic study reveals a significant potential for traffic diversion to another residential roadway. D. Roadway Alignment 1. Speed Humps will not be installed on roadways with severe vertical or horizontal alignment (curves). 2. In no case will a speed hump be installed in a horizontal curve with a radius of less than one-hundred-fifty (150) feet. 3. Speed hump installations must be visible to oncoming motorists for a minimum of two hundred (200) feet. ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 6 E. Roadway Grade Speed humps will not be installed on roadways with a grade greater than five percent i.e., a five-foot (5-foot) vertical rise or fall in one-hundred (100) feet of roadway, in the section where humps are to be installed. F. Roadway Drainage Speed humps will not be installed on roadways with significant drainage problems or on roadways where the hump will cause significant drainage problems. G. Street Width Speed humps will not be installed on roadways less than twenty (20) feet wide or more than thirty (30) feet wide. H. Number of Lanes Speed humps will not be installed on roadways with more than one lane in each direction. I. Roadway Length Speed humps will not be installed on roadways less than six-hundred (600) feet in length. The minimum length is required to provide adequate distance for the installation of advance warning signs and pavement markings. J. Roadway Use Speed humps will not be installed on designated truck or transit routes or on any roadway identified as a primary emergency route by any emergency response agency. ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 7 K. Speed Limit Speed humps will not be installed on roadways with posted speed limits greater than twenty-five (25) miles per hour. L. Prevailing Speed The measured 85th percentile speed must be greater than ten (10) miles per hour above the posted speed limit. M. Physical Conditions 1. Speed humps will not be installed adjacent to or in driveways, over underground access covers, or adjacent to catch basins or drainage structures. 2. Additionally, speed humps will not be installed on roadways in poor condition – the roadway must first be resurfaced. N. Maintenance The roadway must be entirely maintained by Pickens County. O. Speed Hump Design and Composition 1. Speed humps must be a raised area across a travel lane with a travel length of twelve (12) to fourteen (14) feet. 2. Speed humps must be comprised of concrete or asphalt plastic materials. 3. Speed humps comprised of rubber materials, plastic materials or a combination thereof are prohibited. 4. Speed humps shall have markings in accordance with the Federal Highway Administration’s Manual on Uniform Traffic Control Devices (MUTCD). ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 8 P. Emergency Services Response Speed humps will not be placed in areas that may negatively affect Emergency Services Vehicles as determined on a case-by-case basis by the Pickens County Sheriff’s Office and the Pickens County Department of Public Safety. Q. Signage Appropriate signs shall be placed prior to speed humps in accordance with the MUTCD. R. Other Criteria Other criteria not specifically addressed in this policy may be consideration for denial on the basis of an engineering evaluation so warranting denial. III. The Process for Citizens to Request Speed Hump Installation A. All requests for speed humps must be submitted to the Public Works Department for review at the Public Works facility at 3043 Camp Road between the hours of 8 AM and 5 PM. B. Speed Hump Request Applications (“Applications”) can be found on the county website or picked up at the Public Works facility. C. Applications must be submitted by the applicable Homeowner’s Association or its authorized agent. In the absence of a Homeowner’s Association, Applications must be submitted by a property owner of the affected roadway or his or her authorized agent. D. All Applications must be accompanied by a County-certified petition approved by at least eighty percent (80%) of the legal property owners on the affected roadway and approved by at least fifty percent (50%) of the remaining legal property owners within the affected subdivision. 1. Legal property owners of undeveloped lots may sign the petition. ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 9 2. All joint legal owners of a property must sign the petition, including spouses, though the multiple signatures of the respective joint legal owners only count as one vote. 3. For purposes of this requirement, any legal property owners that own more than one property in the affected subdivision will only be counted one time in the petition. 4. Property lessees are not entitled to sign the petition. E. For subdivisions that are not completely built out or are complete, a minimum of seventy percent (70%) of the total planned units must be occupied before a request for installation of a speed hump will be considered. IV. The Review Process A. The Public Works Department 1. Upon receipt of a complete Application, the Public Works Department will conduct the following steps to determine if criteria to justify the installation of any speed humps have been met: a. Collect and analyze traffic data and other information b. Conduct one or more site reviews c. Work with the Pickens County Sheriff’s Office and the Pickens County Department of Public Safety to determine if the proposed speed humps may negatively affect Emergency Services Vehicles d. Determine if a traffic study by an engineer is necessary and commission that study, if deemed necessary 2. If the Public Works Department determines that the request does not indicate that the initial criteria justifying installation of the requested speed ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 10 hump(s) are met, the Applicant will be notified in writing that the Application, as filed, has been rejected. 3. If the Public Works Department determines that the request indicates that the initial criteria may justify the installation of the requested speed hump(s), a recommendation for approval of the request will be provided to the Board of Commissioners for its approval or rejection and the Applicant will be notified of that recommendation in writing. Note: Due to the painstaking nature of gathering and analyzing relevant data and information, the overall review process by the Public Works Department may take up to four months to complete. B. The Board of Commissioners 1. Upon the recommendation of approval of an application by the Public Works Department, the Board of Commissioners (BOC) will approve or reject the application in its sole discretion in a public hearing to be conducted as scheduling allows. a. As is the case with all BOC meetings, the public hearing will be conducted in accordance and in compliance with the Open Meetings Act as enacted by the Georgia General Assembly. b. Letters indicating the meeting dates, times and locations will be mailed to each applicable property owner. c. If the request is denied, the applicant will be notified in writing. 2. In its sole discretion, the BOC may require full or partial payment for the full installation cost from the applicable homeowner or, in the absence of a homeowner association, the residents of the subdivision prior to the installation of the speed humps(s). 3. If approved by the BOC, the Department of Public Works will designate the approved installation as a Public Works Project and place the project on its project list for commencement and completion. ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 11 4. All approvals will contain a stipulation stating that the Public Works Department will not conduct scraping or other maintenance activities on roadways on which speed humps have been installed during periods of time where inclement weather has resulted in roadway conditions impacted by frozen precipitation of any kind. V. The Removal of Speed Humps A. The removal of speed humps may proceed or occur if the Department of Public Works is presented with a petition requesting that the speed humps be removed. B. The percentages of the legal property owners as shown in Section II must vote in favor of removing the speed humps in the manner that is further provided in Section II C. Such a petition for speed hump removal will only be considered after speed humps have been in place for a period of at least three years after final installation. D. The process for considering the removal is the same process set forth in Section III for the approval of requests for the installation of speed humps. E. In its sole discretion, the BOC may require full or partial payment for the full cost of speed hump removal from the applicable homeowner association or, in the absence of a homeowner association, the residents of the subdivision prior to the removal of the speed humps(s). ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 12 APPENDIX B Petition Signature Sheets Subdivision Name: 1. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 2. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 3 Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 13 4. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 5. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 6. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 7. Signature Printed Name (First, Last) ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 14 Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 8. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 9. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 10. Signature Printed Name (First, Last) Witness Witness Contact Information ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 15 Parcel Number Choose One (Circle): Yes or No 11. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 12. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 13. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 16 14. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 15. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 16. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 17. Signature Printed Name (First, Last) ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 17 Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 18. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 19. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 20. Signature Printed Name (First, Last) Witness Witness Contact Information ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 18 Parcel Number Choose One (Circle): Yes or No 21. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 22. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 23. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 19 24. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 25. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 26. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 27. Signature Printed Name (First, Last) ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 20 Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 28. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 29. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 30. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 21 31. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 32. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 33. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 34. Signature Printed Name (First, Last) ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 22 Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 35. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 36. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 37. Signature Printed Name (First, Last) Witness Witness Contact Information ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 23 Parcel Number Choose One (Circle): Yes or No 38. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 39. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 40. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 24 41. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 42. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 43. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 44. Signature Printed Name (First, Last) ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 25 Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 45. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 46. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 47. Signature Printed Name (First, Last) Witness Witness Contact Information ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 26 Parcel Number Choose One (Circle): Yes or No 48. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 49. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 50. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 27 51. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 52. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 53. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 54. Signature Printed Name (First, Last) Witness Witness Contact Information ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 28 Parcel Number Choose One (Circle): Yes or No 55. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 56. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 57. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 29 58. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 59. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 60. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 61. Signature Printed Name (First, Last) ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 30 Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 62. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 63. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 64. Signature Printed Name (First, Last) Witness Witness Contact Information ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 31 Parcel Number Choose One (Circle): Yes or No 65. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 66. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 67. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 32 68. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 69. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 70. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 71. Signature Printed Name (First, Last) Witness Witness Contact Information ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 33 Parcel Number Choose One (Circle): Yes or No 72. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 73. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 74. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 75. Signature Printed Name (First, Last) ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 34 Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 76. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 77. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 78. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No ---PAGE BREAK--- PICKENS COUNTY PUBLIC WORKS DEPARTMENT 3043 Camp Road, Jasper, GA 30143 Phone [PHONE REDACTED] Email: [EMAIL REDACTED] Fax [PHONE REDACTED] Application for Speed Hump Installation 35 79. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No 80. Signature Printed Name (First, Last) Witness Witness Contact Information Parcel Number Choose One (Circle): Yes or No