The following are samples of forms used by the State Highway Administration for permit issuance. These forms are reproducible for the applicant's use, or can be obtained by contacting the local State Highway Administration Office listed previously.


DATE ________________ Application is hereby made for a permit to construct a residential driveway at the following location: County ______________________________ State Highway Route Number ______________________________ State Highway Route Name ______________________________ House Number ______________________________ ______________________________ | This side to be completed only if Federal ID # and/or Social | the applicant is not the owner. Security # | | ______________________________ | ______________________________ Applicant Signature | Owner Name | ______________________________ | ______________________________ ______________________________ | ______________________________ Address | Address | ______________________________ | ______________________________ Telephone | Telephone BOND: One of the following in the amount of $1,000.00 made payable to the State of Maryland: 1. Cashier's Check 2. Certified Check 3. Performance Bond (from an insurance company), or 4. Letter of Credit (from a bank). PLANS: Two copies of the following are to be submitted: 1. A site plan (to scale) showing the proposed driveway in relation to the State Highway 2. A vicinity map, and 3. A copy of the record plat. ______________________________________________________________________ TO BE COMPLETED BY THE MSHA INSPECTOR: Drainage specifications: Valley gutter - Fall __________ Distance __________ Pipe - Size __________