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5. Only ONE access location per application
7. Permit Type*
   -- Select One --ResidentialFieldCommercialAccessoryTemporaryAG Preservation Plat
9. Upload attachments
10. *if Accessory Drive, see requirements item #1 listed in the guidelines for driveway permits
    Guidelines for Driveway Permits
11. If Commercial, AG preservation or Accessory, please provide site plan*
12. If Temporary, list date to be removed:*
    If Temporary, list date to be removed:
14. Application is hereby made to Lancaster County Engineering Department: Pursuant to County Board Resolution #3708 by:
16. Property Owner*
17. Email Address
19. Mailing Address*
20. City*
21. State*
23. Zip Code*
24. Daytime Phone Number*
25. Cell Phone Number
27. Is there a Second Applicant or an Agent for the Owner?*

    1. Yes
    2. No
31. Applicant 2 / Agent*
    Agent, If different from owner add company name
32. Email Address*
34. Mailing Address*
35. City*
36. State*
38. Zip Code*
39. Daytime Phone Number*
40. Cell Phone Number
44. Legal Description of Property
46. Legal descriptions can be found at the following link
    Lincoln/Lancaster County GIS Viewer
48. Legal Type to use*

    1. Subdivision
    2. Irregular Tract
50. Subdivision*
51. Lot #*
52. Block #
54. Irregular Tract #*
    or Fractional part of Section(if applicable)
56. 1/4 Section
    -- Select One --NENWSESW
57. Section*
    -- Select One --123456789101112131415161718192021222324252627282930313233343536
58. Township*
    -- Select One --6 N7 N8 N9 N10 N11 N12 N13 N
59. Range*
    -- Select One --4 E5 E6 E7 E8 E9 E
61. If in an adjacent county, list the county
    -- Select One --ButlerCassGageOtoeSalineSaundersSeward
65. Driveway Information
67. Is this an Existing Driveway?*

    1. Yes
    2. No
68. Requested Drive Width(in Feet)*
    (Residential or Accessory = 16' Min, 25' Max. Field or Commercial 35' Max.)
70. If the property has existing address list here:
71. List name of street for Drive to Access:*
73. Has the Driveway been Flagged?*

    1. Yes
    2. No

    Flags are available at the County Engineers office or at Maintenance Stations
74. If not what date will the location be flagged?
    If not what date will the location be flagged?
75. How is the location flagged?*
    List material used
77. What is the approximate distance to the nearest cross street(in feet)
78. Nearest cross street name
79. Approximate date to begin construction*
    Approximate date to begin construction
81. Do you require an onsite meeting with a District Supervisor?*

    1. Yes
    2. No
83. Owner/Applicant Comments:
87. Signature page
    The owner/applicant declares that all information provided on this form is to the best of their knowledge, true and complete. They further understand receipt of the driveway permit does not constitute approval to begin any building construction. Also, the owner/ applicant agrees to notify County Engineering Department when work covered by this permit has been completed and is ready for final inspection and installation approval.
89. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
91. Signature of Owner
92. Date
    Date
94. Owner/Applicant must sign within 48 hours of submitting permit to continue the application process. If the applicant is not the owner of the property, we require this application also to be signed by the property owner or their legally authorized representative. This signature shall constitute agreement with this application by all owners-of -interest unless otherwise stated in writing. If a permit is issued, the property owner, in most cases will be listed as the Permittee.
96. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
98. Signature of Applicant Required(if not owner)
99. Date
    Date
101. Allow a minimum of 7-10 working days for permit processing, weather permitting.
117. CORRUGATED METAL PIPE CULVERT shall be installed by the applicant at their expense. Plastic Culvert Pipe is NOT allowed.
127. NOTE: Final acceptance and approval for this access is contingent upon compliance with the access permit requirements and application guidelines as determined by a post construction/installation field inspection
Leave This Blank:


135. 1. Receive an email copy of this form.
136. Email address

     This field is not part of the form submission.

137. Submit Submit and Print

* indicates a required field