NOTE: Keep entries in fields short. Text or numbers that aren't visible won't print.
DOT256 - Rev. 12/2015
SOUTH DAKOTA DEPARTMENT OF TRANSPORTATION
PERMIT APPLICATION FOR BUSINESS SIGNS ON SPECIFIC AND SUPPLEMENTAL INFORMATION PANELS



BUSINESS LOCATION DATA
Dir:

Miles (To Nearest Tenth Mile)
SERVICE DETAILS (Check all obtained/available/apply for each category which you are requesting signs.)
3. GAS




4. FOOD




5. LODGING

6. CAMPING



7. ATTRACTIONS




CATEGORY



8. Applicable License Nos. or Permit Nos.

By Whom Issued:

Date Issued:

9. Business Hours: A.M. P.M.
days
11. Months of Operation:
Month Day Month Day

13. Type of Signs Requested:
(Applications for business signs at interchanges shall be for both a specific and a supplemental panel)
14. Sign Information For: Eastbound Traffic
Northbound Traffic
15. Fee in Amount of $ Remitted For:
NumberNumber
(NOTE: Application Fee of $50.00 Must Accompany Application For Each Specific and Each Supplemental Sign Requested.) Non-Refundable.
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APPLICANTS CERTIFICATION
I certify that the above and foregoing statements are true and correct and I will inform the Department of any changes to the above indicated information that may affect the availability of the service provided in accordance with State Law, Rules and Regulations. I further certify that I will not discriminate or deny services or public accommodations based upon race, religion, color or national origin, which is prohibited by Law.

_______________________________________________________________________ _________________
Applicants Name (Printed) Applicant’s Signature Date
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DEPARTMENT OF TRANSPORTATION USE
Region
Highway No.
Exit / Intersection

Application Fee
Date Fee Received
Annual Fee

Remarks


RECOMMENDED FOR APPROVAL: APPROVED:

____________________________________________ _____________________________________________
Region Beautification AgentDate Division of OperationsDate

Approval of this application shall constitute the permit contemplated by ARSD 70:01:06:.02
Distribution after approval:Copy - Operations Copy - Region Office Copy - Applicant


INSTRUCTIONS
NAME OF BUSINESS: Self Explanatory
ADDRESS: Self Explanatory

BUSINESS LOCATION DATA:

1. Highway No.: The route number of the highway on which you want to place a business sign.

Interchange No.: If the business sign is requested to be placed at an interchange, the exit number of that interchange.

Intersecting Highway Numbers: The route number of the highway that intersects the highway on which you want to place a business sign.

Direction: Direction the business is located from the intersection or interchange.

2. Travel Distance: The distance from the exit ramp terminal of an interchange or the intersection to your place of business along the normally used route of travel measured to the nearest one tenth of a mile. Businesses beyond 15 miles are not eligible for a business sign.

3 - 7. SERVICE DETAILS: Circle the type of business sign you are requesting. If you do not provide all the services listed beneath it, you may not be eligible for a business sign.

8. Examples of Licenses: Sales Tax, Health Department and any other state or local applicable licenses or permits.

9. Gas Service must be open a minimum of 16 continuous hours a day. Food Service must be in continuous operation to provide 2 meals a day.

10-12. Business must be open five (5) days a week for four (4) consecutive months as a minimum requirement for approval of this application.

13. If you are requesting business signs to be placed at an interchange, check “Specific” and “Supplemental” or “Both” as both a specific and supplemental sign are required at all interchanges. If the request is for an intersection, check “Specific” only as this is the only type of sign allowed.

14. Place a check after the lane of travel from which you want the business sign to be seen as the traffic approaches the interchange or the intersection. If you want business signs to be placed on both sides of the interchange or intersection, check “Both”.

15. A $50.00 application fee is required for each business sign that is requested. If the request is for a sign to be placed on a specific and a supplemental panel for one exit ramp of an interchange, the application fee is $100.00. If the request is for signs to be placed on both exit ramps, the application fee is $200.00. Enter the amount being remitted and the number of each type of sign requested.

NOTE: If the application is approved you will have sixty (60) days in which to remit your annual rental fee in the amount of $155.00 for each specific information sign and each supplemental sign, and will be billed on a yearly basis on the anniversary date of the application approved date at the rental rate established. You also have sixty (60) days from the approval date to deliver your business signs to the designated place stated on your approved copy of the application.

Any required trailblazing signs shall be installed prior to any business sign being installed at the interchange, intersection or ramp.

The completed application and the required fee payment are to be submitted to one of the following offices:

Department of Transportation
PO Box 1767
Aberdeen, SD 57401-1767
Phone (605) 626-2244

Department of Transportation
104 S. Garfield Ave.
Pierre, SD 57501-5405
Phone (605) 773-3464
Department of Transportation
PO Box 1206
Mitchell, SD 57301-7206
Phone (605) 995-8129

Department of Transportation
PO Box 1970
Rapid City, SD 57709-1970
Phone (605) 394-2244