DOT Application for At-Grade Crossing

A nonrefundable application fee of $175 must accompany this application.

Application for At-Grade Crossing

Office of Air, Rail and Transit - Railroads
South Dakota Department of Transportation
700 E. Broadway Ave. Pierre, SD 57501
(605) 773-3222 perry.griffith@state.sd.us

NOTICE

This form is for state-owned railroads only, which include Napa-Platte, Yale and Britton.

Applicant information

Nearest city, town or village

State

Phone

Applicant's full name and address

Date

Corporation - If yes, in what state is it incorporated?

Individual - If yes, under what firm name is business conducted?

Partnership - If yes, please provide names of all partners

Crossing information

What is the purpose of the crossing?

Will the crossing be temporary or permanent? Temporary Permanent

If temporary, how long will it be used?

Will the crossing be public or private? Public Private

If the crossing will be public, identify the road or highway involved

Which entity (town, county, state) is responsible for road or highway?

Certification

A drawing showing approximate distance from the nearest switch, bridge, culvert or some fixed location, but not from a mile board, must be submitted with this application. Also, complete engineering plans for the construction of the crossing must be submitted with this application.

It is understood that the applicant will execute a formal agreement covering the crossing when presented, and that an annual fee, as determined by the Office of Air, Rail and Transit, will be charged under the formal agreement. It is further understood, if the crossing is to be temporary, the applicant will provide flagmen if required by the Office of Air, Rail and Transit. Also, that applicant will furnish all necessary material and install the crossing at the applicant’s sole expense under the supervision of the Office of Air, Rail and Transit, or reimburse the State’s operator for costs incurred by the operator for crossing installation.

__________________________________
Applicant signature

__________________
Date

Mail to:

S.D. Dept. of Transportation
Office of Air, Rail and Transit
700 E. Broadway Ave.
Pierre, SD 57501-2586

Note: All applications for crossings are subject to review by the Staff Engineer of Air, Rail and Transit. Suitability of crossing plans will be determined on the basis of crossing location, design and purpose.

Application approval (SDDOT use only)

________________________________ _______________________________ __________
Air, Rail and Transit Date Program Manager, Air, Rail and Transit Date

Page 1 of 1 3/2016