Laserfiche WebLink
Application Number ea' ($ • <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 • .• 'I Meg-- Agent !V r <br /> Address OAS, ciliA11404. W <br /> Telephone Cop t: t4 1-60 - �''�-Z• ' <br /> n <br /> Location , . <br /> I. Town Road Name � �1�.� LAx. <br /> 2. Distance and direction from nearest intersection „= "';. <br /> 3, Side of Town Road(circle one) North South East <br /> 4. Fire Number or Lot Number/Subdivision Name <br /> 5. Location of new driveway is'ZAt, feet(circle one) c4,1120 South !` West <br /> of nearest driveway.Fire Number I I <br /> 6. Location of new driveway is on(circle one) same pposit side as nearest driveway <br /> Proposed Access Use <br /> Residential,Number of dwelling units <br /> Commercial,Number of Parking Spaces <br /> Agricultural <br /> Other <br /> Construction Material <br /> Concrete <br /> Asphalt <br /> Gravel <br /> Other(explain) <br /> Culvert Size le Length.=a 4• Type Coe ,K �i L. 44 L.). <br /> Not required(explain) •--- ta sq�C <br /> Applicant has completed the attached checklist and agrees to install the driveway in accordance <br /> with the provisions e checklist and the Town of Roxbury Driveway Permit Ordinance <br /> • <br /> Signed Date t.-1,6r <br /> Approved y the Town of Roxbury Date „43/.4,,..- <br /> APPROVED <br />