Administrative Rules of the State of Montana

(1) The following applications and permits shall be utilized by the Department.

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Conditional Application for Extension of Time to Remove a Provate Encroachment

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Conditional Agreement for the Removal of a Private Encroachment

APPLICATION FOR EXTENSION OF TIME TO REMOVE A PRIVATE ENCROACHMENT

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�� Application is hereby made for an extension of time, as provided by the Right of Way Encroachment Policy dated May 29, 1969, approved by the State of Montana - Department of Highways, to maintain a private encroachment located within the right of way limits of the highway as herein described.

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Date: ��

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Name of Applicant (if a corporation, give State of incorporation and names of President and Secretary) : ��

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Address: ��

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Specifically describe the encroachment (include type and dimensions of encroachment) : ��

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Location of Encroachment (highway, number and milepost, or street or Project No. and Survey Stations) : ��

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State reason extension is desired: ��

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Period of time desired: ��

Additional remarks: ��

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I hereby certify that the above information is true and correct, and that I have read and understand the terms and conditions of the attached Agreement and will abide by same upon execution of said Agreement.

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�� Applicant

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�� Title

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Division: �� Designation: ��

Project: �� Milepost: ��

F. A. Route: �� City & County: ��

Street Address: ��

�� Application No: ��

9/69 �� A G R E E M E N T

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5/72

�� FOR THE REMOVAL OF A PRIVATE ENCROACHMENT

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�� Subject to the following terms and conditions, and in consideration of the mutual covenants and considerations by and between �� , hereinafter referred to as Owner, and the State of Montana - Department of Highways, hereinafter referred to as State, it is mutually agreed as follows:

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�� THAT in forbearance of enforcement action by the State, the Owner of the encroachment specifically described on the "Application for Extension of Time", attached hereto and made a part hereof, shall remove said encroachment on or before the �� day of �� , 19 �� , or unless the same is required to be removed prior thereto as provided herein and governed by the Right of Way Encroachment Policy as adopted.

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THAT in the event the encroachment is determined by the State as hazardous to the safety of traffic or persons, or becomes in conflict, or interferes with the proper use of the highway, the State may require removal or adjustments to conform to the Uniform Encroachment Standards by providing thirty (30) days notice addressed to the Owner at his address as stated in the application.

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THAT the Owner shall only maintain said encroachment in normal and proper manner until removal has been accomplished.

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THAT modifications, replacement or removal shall not be considered maintenance, and shall require immediate removal. Owner shall not erect additional devices, either permanent or portable, in conjunction with or separate from the existing encroachment in violation of the State of Montana - Department of Highways Right of Way Encroachment Policy. If such additional devise is erected the Owner shall be required to remove all encroachments.

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THAT the State shall have the right to terminate this Agreement on sixty (60) days notice addressed to the Owner at his address stated in the application and shall have the right to require removal of the encroachment at the termination of said notice. This Agreement shall become void without giving said notice in the event Owner violates any of the conditions or terms set forth herein.

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THAT Owner shall protect and save the State harmless from all claims, actions or damage of every kind and description which may accrue to, or be suffered by, any person or persons which may arise from the maintenance of said encroachment.

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IN WITNESS WHEREOF, the parties have caused this Agreement to be executed the day and year first above written.

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Owner

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Title

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ATTEST:

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STATE OF MONTANA - DEPARTMENT OF HIGHWAYS

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Recommended By:

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Manager - Field Right of Way Unit

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Address: ��

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APPROVED:

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Supervisor - Right of Way Section, or

Assign

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(Project Affected) (Maintenance Number)

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�� APPLICATION FOR PERMIT TO

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(Insert Nature of Permit)

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1. �� Name of Applicant:

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2. �� Address of Applicant:

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3. �� If Applicant is a Corporation give State of incorporation and names of President and Secretary:

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4. �� Nature of Permit desired: (Give sufficient detail to permit thorough understanding, and submit blueprints or sketches, in triplicate, if desired by Chief - Field Maintenance Bureau.

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5. �� Highway survey stations at or near which installations or structures will be installed:

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6. �� For how long a period is the permit desired:

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7. �� REMARKS:

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�� Dated at �� , Montana, this �� day of �� , 19 � .

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(Signature of Applicant)

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(INSTRUCTIONS CONCERNING USE OF THIS FORM)

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Applicant will complete this form in triplicate and transmit it to the Chief, Field Maintenance Bureau within whose division the highway affected is situated. Chief, Field Maintenance Bureau will, if the application is for a minor encroachment, i.e., installation of water, sewer, approaches, gas, and irrigation pipe, etc., and if he approves application, sign permit form on reverse side hereof. If application is for major encroachments, i.e., railroad crossings, attaching pipe lines to bridges, etc., the Chief, Field Maintenance Bureau will forward form in triplicate to the Helena Office together with letter of transmittal giving full information and recommendation. When application is approved and applicant has signed acceptance, the original will be delivered to him. If Permittee desires, he may sign acceptance at time of signing application. Rev. 11/21/78

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�� P E R M I T

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Subject to the following terms and conditions, the permit applied for upon the reverse side hereof, is hereby granted:

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1. �� TERM. This permit shall be in full force and effect from the date hereof until revoked as herein provided.

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2. �� RENTAL. Rental shall be

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3. �� REVOCATION. This permit may be revoked by State upon giving___ days notice to Permittee by ordinary mail, directed to the address shown in the application hereto attached, but the State reserves the right to revoke this permit without giving said notice in the event Permittee breaks any of the conditions or terms set forth herein.

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4. �� COMMENCEMENT OF WORK. No work shall be commenced until Permittee notifies Chief-FMB shown in application when he proposes to commence work.

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5. �� CHANGES IN HIGHWAY. If State changes highway necessitating changes in structures or installations installed under this permit, Permittee shall make necessary changes without expense to State.

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6. �� STATE SAVED HARMLESS FROM CLAIMS. In accepting this permit the Permittee, its/his successors or assigns agree to protect the State and save it harmless from all claims, actions or damage of every kind and description which may accrue to, or be suffered by, any person or persons, corporations or property by reason of the performance of any such work, character of materials used, or manner of installations, maintenance and operation, or by the improper occupancy of said highway right of way, and in case any suite or action is brought against the State and arising out of, or by reason of, any of the above causes, the Permittee, its/his successors or assigns, will, upon notice to it/him of the commencement of such action, defend the same at its/his sole cost and expense and satisfy any Judgment which may be rendered against the State in any suite or action.

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7. �� PROTECTION OF TRAFFIC. Insofar as the interests of the State and the traveling public are concerned, all work performed under this permit shall be done under the supervision of the Chief-FMB of the Montana Department of Highways and his authorized representatives, and he/they shall indicate the traffic control devices, the lighting thereof at night, placing of flagmen and watchmen, the acceptable manner in which traffic is to be handled, and shall specify to Permittee how road surface is to be replaced if it is disturbed during operations, but said supervision shall in no way operate to relieve or discharge Permittee from any of the obligations assumed by acceptance of this permit, and especially those set forth under Section 6 hereof.

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8. �� HIGHWAY DRAINAGE. If the work done under this permit interferes in any way with the drainage of the State highway affected, Permittee shall, at its/his own expense, make such provisions as the State may direct to take care of said drainage.

9. �� RUBBISH AND DEBRIS. Upon completion of work contemplated under this permit, all rubbish and debris shall be immediately removed and the roadway and roadside left in a neat and presentable condition satisfactory to the State.

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10. �� WORK TO BE SUPERVISED BY STATE. All work contemplated under this permit shall be done under the supervision of and to the satisfaction of the authorized representative of the State, and the State hereby reserves the right to order the change of location or removal of any structure or installation authorized by this permit at any time, said changes or removal to be made at the sole expense of the Permittee.

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11. �� STATE'S RIGHT NOT TO BE INTERFERED WITH. All such changes, reconstructing or relocation shall be done by Permittee in such a manner as will cause the least interference with any of the State's work, and the State shall in no wise be liable for any damage to the Permittee by reason of any such work by the exercise of any rights by the State upon the highways by the installations or structures placed under this permit.

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12. �� REMOVAL OF INSTALLATIONS OR STRUCTURES. Unless waived by the State, upon termination of this permit, the Permittee shall remove the installations or structures contemplated by this permit and restore the premises to the condition existing at the time of entering upon the same under this permit, reasonable and ordinary wear and tear and damage by the elements, or by circumstances over which the Permttee has no control, excepted.

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13. �� MAINTENANCE AT EXPENSE OF PERMITTEE. Permittee shall maintain, at its/his sole expense the installations and structures for which this permit is granted, in a condition satisfactory to the State.

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14. �� STATE NOT LIABLE FOR DAMAGE TO INSTALLATIONS. In accepting this permit the Permittee agrees that any damage or injury done to said installations or structures by a contractor working for the State, or by any State employee engaged in construction, alteration, repair, maintenance or improvement of the State highway, shall be at the sole expense of the Permittee.

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15. �� STATE TO BE REIMBURSED FOR REPAIRING ROADWAY. Upon being billed therefor Permittee agrees to promptly reimburse State for any expense incurred in repairing surface of roadway due to settlement at installation, or for any other damage to roadway as a result of the work performed under this permit.

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16. �� OTHER CONDITIONS AND/OR REMARKS.

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Dated at �� , Montana, this �� day of �� , 19 �� .

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The undersigned, the "Permittee" mentioned �� STATE HIGHWAY COMMISSION

in the forgoing instrument, hereby accepts

this permit, together with all of the terms

and conditions set forth therein.

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�� By ��

(Chief - Field Maintenance Bureau)

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(Permittee) (Place)

(Project Affected) (Maintenance Number)

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APPLICATION FOR PERMIT TO

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(Insert Nature of Permit)

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1. �� Name of Applicant: ��

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2. �� Address of Applicant: ��

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3. �� If Applicant is a Corporation, give State of Incorporation and names of President and Secretary:

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4. �� Nature of Permit desired: (Give sufficient detail to permit thorough understanding, and submit blue prints or sketches, in triplicate.) ��

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5. �� Highway Survey Stations at or near which installations or structures will be installed: ��

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6. �� For how long a period is the permit desired: � ��

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7. �� REMARKS: ��

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Dated at �� , Montana, this �� day of �� , 19_ ��

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�� (Signature of Applicant)

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(INSTRUCTIONS CONCERNING USE OF THIS FORM)

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Applicant will complete this form in triplicate and transmit to the proper Chief Field Maintenance Bureau within whose Bureau the Highway affected is situated. � The Chief Field Maintenance Bureau will forward form in triplicate to the proper Helena Office together with letter of transmittal giving full information and recommendation. � When application is approved and applicant has signed acceptance, the original will be delivered to him. � If Permittee desires, he may sign acceptance at time of signing application. Rev. 3/7/72

�� PERMIT

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Subject to the following term: and conditions, the permit applied for upon the reverse side hereof, is hereby granted:

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1. �� TERM. This permit shall be in full force and effect from the date hereof until revoked as herein provided.

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2. �� RENTAL OR FEES. Fees shall be

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3. �� REVOCATION. This permit may be revoked by State upon giving 180 days notice to Permittee, except in emergency cases and then in no event less than 30 days by ordinary mail, directed to the address shown in the application hereto attached, but the State reserves the right to revoke this permit without giving said notice in the event Permittee breaks any of the conditions or terms set forth herein.

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4. �� COMMENCEMENT OF WORK. No work shall be commenced until Permittee notifies the proper Chief - Field Maintenance Bureau shown in the application, when he proposes to commence work.

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5. �� CHANGES IN HIGHWAY. If State changes highway necessitating changes in structure or installations installed under this permit, Permittee shall make necessary changes without expense to State.

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6. �� STATE SAVED HARMLESS FROM CLAIMS. In accepting this permit the Permittee, its/his successors or assigns, agree to protect the State and save it harmless from all claims, actions or damage of every kind and description which may accrue to, or be suffered by, any person or persons, corporations or property by reason of the performance of any such work, character of materials used, or manner of installations, maintenance and operation, or by the improper occupancy of said highway right of way, and in case any suit or action is brought against the State and arising out of, or by reason of, any of the above causes, the Permittee, its/his successors or assigns, will, upon notice to it/him of the commencement of such action, defend the same at its/his sole cost and expense and satisfy any judgment which may be rendered against the State in any such suit or action.

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7. �� PROTECTION OF TRAFFIC. Insofar as the interests of the State and the traveling public are concerned, all work performed under this permit shall be done under the supervision of the Chief - Field Maintenance Bureau of the Department of Highways and his authorized representatives, and he/they shall indicate barriers to be erected, the lighting thereof at night, placing of flagmen and watchmen, manner in which traffic is to be handled, and shall specify to Permittee how road surface is to be replaced if it is disturbed during operations, but said supervision shall in no way operate to relieve or discharge Permittee from any of the obligations assumed by acceptance of this permit, and especially those set forth under Section 6, hereof.

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8. �� HIGHWAY AND DRAINAGE. If the work done under this permit interferes in any way with the drainage of the State Highway affected, Permittee shall, at its/his own expense, make such provisions as the State may direct to take care of said drainage.

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10. �� WORK TO BE SUPERVISED BY THE STATE. All work contemplated under this permit shall be done under the supervision of and to the satisfaction of and to the authorized representative of the State, and the State hereby reserves the right to order the change of location or removal of any structure or installation authorized by this permit at any time, said changes or removal to be made at the sole expense of the Permittee.

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11. �� STATE'S RIGHT NOT TO BE INTERFERED WITH. All such changes, reconstructing or relocation shall be done by Permittee in such a manner as will cause the least interference with any of the State's work, and the State shall not be liable for any damage to the Permittee by reason of any such work by the State, its agents, contractors or representatives, or by the exercise of any rights by the State upon the highways by the installations or structures placed under this permit.

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14. �� STATE NOT LIABLE FOR DAMAGE TO INSTALLATIONS. In accepting this permit the Permittee agrees that any damage or injury done to said installations or structures by any State employee engaged in construction, alteration, repair, maintenance or improvement of the State Highway, shall be at the sole expense of the Permittee.

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15. �� STATE TO BE REIMBURSED FOR REPAIRING ROADWAY. Upon being billed therefor Permittee agrees to promptly reimburse State for any expense incurred in repairing surface of roadway due to settlement at installation, or for any other damage to roadway or structure as a result of the work performed under this permit.

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16. �� OTHER CONDITIONS AND/OR REMARKS.

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Dated at �� , Montana, this �� day of �� , 19 �� .

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The undersigned, the "Permittee" �� STATE OF MONTANA

mentioned in the foregoing instrument, �� DEPARTMENT OF HIGHWAYS

hereby accepts this permit together

with all of the terms and conditions

set forth therein.

�� By ��

�� (Chief-Field Maintenance Bureau)

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(Permittee) (Place)

Sub-Chapter 2

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�� Right-of-Way Occupancy by Utilities