DRIVEWAY PERMIT
TOWN OF
REQUIRED FEE $
20.00
NAME OF PERSON REQUESTING PERMIT _____________________________________________________
ADDRESS: ____________________________________________________________________________
_______________________________________________________________________________
PHONE NUMBER: _________________________________________
LOCATION
SECTION ________________ TOWNSHIP_______________ RANGE_____________________
NAME OF ROAD:_____________________________________________________________________
TYPE OF DRIVEWAY:________________________________________________________________
SIZE OF DRAINANGE
STRUCTURE REQUIRED: _______________________________________
DESCRIPTION OF REQUIRED WORK, SPECIAL RESTRICTION, OTHER DETAILS OR
SKETCHES:
PLEASE CLEARLY MARK DRIVEWAY WITH FLAGS
OR POSTS BEFORE SENDING IN THIS PERMIT SO INSPECTION CAN BE COMPLETED
ISSUANCE OF THIS PERMIT SHALL NOT BE CONSTRUED AS A WAIVER OF THE
APPLICANT’S OBLIGATION TO COMPLY WITH ANY MORE RESTRICTION REQUIREMENTS IMPOSED
BY THE
THE APPLICANT ACKNOWLEDGES THAT HE HAS READ THE TOWN
OF
________________________________________ ______________________
SIGNATURE OF
APPLICANT
DATE
____________________ ________________________________ ________________
DATE OF APPROVAL APPROVED BY
PERMIT #
_____________________________________ ________________________________________________