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61:10 1 <br />010 Will <br />. .• . <br />ON -SYSTEM COUNTY ROAD ESTABLISHMENT <br />APPLICATION <br />Pursuant to KCC Title 11 <br />NON-REFUNDABLE FEE - $3,770.00 <br />A pre -application meetinn is encouraged for this application. The more information the County has <br />early in the development process, the easier it is to identify and work through issues and conduct an <br />efficient review. To schedule a pre -application meeting, contact the Public Works Department. Notes or <br />summaries from pre -application meetings should be included with this application. <br />Please type or print clearly in ink. Attach additional sheets as necessary. The following items must <br />be attached to the application packet. <br />REQUIRED ATTACHMENTS <br />0 Completed application form. <br />to Map(s) and document(s) of proposed on -system road establishment showing subject parcel(s), <br />adjacent landowners, and other relevant records. <br />® Certificate of Title (Title Report) issued within 30 days of the date of application. <br />® Application fee. <br />APPLICATION FEE: <br />$3,770.00 Kiltitas County Public Works Department (KCPWD) <br />$3,770.00 Total fees due for this application (One check made payable to KCPWD) <br />FOR STAFF USE ONLY <br />Application received by: Date: Receipt No.: <br />ff��tG t I <br />PWD Staff Signature <br />�:1 Irl •l z PAY � -Gl i-iI <br />411 North Ruby Street, Suite 1 <br />Ellensburg, WA 98926 <br />Last Revised on May 24, 2021 <br />Page 1 of 4 <br />ED <br />:%ll IIAs _ IuiiI Y <br />0i PT 01'01 JR1 Ir kni: <br />TEL: (509) 952-7523 <br />FAX: (509) 962-7663 <br />