NCDOT Driveway PermitAPPLICATION IDENTIFICATION N.C. DEPARTMENT OF TRANSPORTATION
Driveway
Permit No. Date of
Application STREET AND DRIVEWAY ACCESS
County: PERMIT APPLICATION
Development Name:
LOCATION OF PROPERTY:
Route/Road:
Exact Distance Miles N S E W
Feet
From the Intersection of Route No. and Route No. Toward
Property Will Be Used For: Residential /Subdivision Commercial Educational Facilities TND Emergency Services Other
Property: is is not within City Zoning Area.
AGREEMENT
• I, the undersigned property owner, request access and permission to construct driveway(s) or street(s) on public right-
of-way at the above location.
• I agree to construct and maintain driveway(s) or street entrance(s) in absolute conformance with the current “Policy on
Street and Driveway Access to North Carolina Highways” as adopted by the North Carolina Department of
Transportation.
• I agree that no signs or objects will be placed on or over the public right-of-way other than those approved by NCDOT.
• I agree that the driveway(s) or street(s) will be constructed as shown on the attached plans.
• I agree that that driveway(s) or street(s) as used in this agreement include any approach tapers, storage lanes or
speed change lanes as deemed necessary.
• I agree that if any future improvements to the roadway become necessary, the portion of driveway(s) or street(s)
located on public right-of-way will be considered the property of the North Carolina Department of Transportation, and I
will not be entitled to reimbursement or have any claim for present expenditures for driveway or street construction.
• I agree that this permit becomes void if construction of driveway(s) or street(s) is not completed within the time
specified by the “Policy on Street and Driveway Access to North Carolina Highways”.
• I agree to pay a $50 construction inspection fee. Make checks payable to NCDOT. This fee will be reimbursed if
application is denied.
• I agree to construct and maintain the driveway(s) or street(s) in a safe manner so as not to interfere with or endanger
the public travel.
• I agree to provide during and following construction proper signs, signal lights, flaggers and other warning devices for
the protection of traffic in conformance with the current “Manual on Uniform Traffic Control Devices for Streets and
Highways” and Amendments or Supplements thereto. Information as to the above rules and regulations may be
obtained from the District Engineer.
• I agree to indemnify and save harmless the North Carolina Department of Transportation from all damages and claims
for damage that may arise by reason of this construction.
• I agree that the North Carolina Department of Transportation will assume no responsibility for any damages that may
be caused to such facilities, within the highway right-of-way limits, in carrying out its construction.
• I agree to provide a Performance and Indemnity Bond in the amount specified by the Division of Highways for any
construction proposed on the State Highway system.
• The granting of this permit is subject to the regulatory powers of the NC Department of Transportation as provided by
law and as set forth in the N.C. Policy on Driveways and shall not be construed as a contract access point.
• I agree that the entire cost of constructing and maintaining an approved private street or driveway access connection
and conditions of this permit will be borne by the property owner, the applicant, and their grantees, successors, and
assignees.
• I AGREE TO NOTIFY THE DISTRICT ENGINEER WHEN THE PROPOSED WORK BEGINS AND WHEN IT IS
COMPLETED.
2004-07 NOTE: Submit Four Copies of Application to Local District Engineer, N.C. Department of Transportation TEB 65-04rev.
61-03419
NEW HANOVER COUNTY
WAWA - #6132
SCOTTS HILL MEDICAL DRIVE
181
X X X
US-17
SCOTTS HILL
MEDICAL DRIVE SENCA DRIVE
X
X WILMINGTON
SIGNATURES OF APPLICANT
PROPERTY OWNER (APPLICANT) WITNESS
COMPANY NAME
SIGNATURE SIGNATURE
ADDRESS ADDRESS
Phone No.
AUTHORIZED AGENT WITNESS
COMPANY NAME
SIGNATURE SIGNATURE
ADDRESS ADDRESS
Phone No.
APPROVALS
APPLICATION RECEIVED BY DISTRICT ENGINEER
SIGNATURE DATE
APPLICATION APPROVED BY LOCAL GOVERNMENTAL AUTHORITY (when required)
SIGNATURE TITLE DATE
APPLICATION APPROVED BY NCDOT
SIGNATURE TITLE DATE
INSPECTION BY NCDOT
SIGNATURE TITLE DATE
COMMENTS:
WILMINGTON (SCOTTS HILL) WW, LLC
361 SUMMIT BLVD, SUITE 110
BIRMINGHAM, AL 35243 205-968-9217