Laserfiche WebLink
�� - _ <br /> aASON.AND KF.I:Lt KIRCH <br /> r' ua�Fanx 7225 LINSLEY LANE <br /> FOUNDATION . '(SA UK CM,WI 53583 <br /> GRAN 01141II <br /> '' ° Application Number 2 0 lc • 3 <br /> APPLICATION FOR DRIVEWAY/ACCESS PERMIT <br /> TOWN OF ROXBURY <br /> The undersigned hereby applies for a permit to construct a new driveway or modify or change <br /> the use of an existing driveway connected to a Town Road. <br /> Names: Owner X�A I-Ktl(, K.x.A Agent <br /> Address — — <br /> _ :,,,e C L137 S 55/5) <br /> Telephone - ,31-3-61S y — —_ <br /> Location <br /> 1. Town Road Name Q(114 W( Z Pole <br /> 2. Distance and direction !ro nearest int section Lk)/ <br /> 3. Side of Town Road (circle one) ort South, ,East West <br /> 4. Fire Number or Lot Number/Su 'vision Name lot 4Z/ <br /> 5. Location of new driveway is / Io feet(circle one) North South l;as West <br /> of nearest driveway. Fire Number 7 2. (( <br /> 6. Location of new driveway is on(circle one) same side as nearest driveway <br /> Proposed Access Use <br /> 4 Residential,Number of dwelling units <br /> Commercial,Number of Parking Spaces <br /> Agricultural <br /> Other <br /> Construction Material <br /> .4_. Concrete <br /> Asphalt <br /> Gravel <br /> _^ Other(explain) <br /> .8 <br /> Culvert Size /1 Length 3e r Type 4.I,t.t.. .igrss�ia /f'frwrK_ /....../VW <br /> Not required(explain) "9/44r•}4__-_adilvs..•..iet_.$ <br /> Applicant has completed the attached checklist and agrees to install the driveway in accordance <br /> with the provisions of e checklist and the Town of Roxbury Driveway Permit Ordinance <br /> � <br /> Signed _ Date P2 �( <br /> Appro - r d by the Town of Roxbury Date S' <br /> APPROVED <br /> 1 <br />