Laserfiche WebLink
• <br /> Application Number c->/ / <br /> APPLICATION FOR DRIVEWAY/A.C C ESS I-TRAM* <br /> TOWN OE ROXBURY <br /> The undersigned hereby applies for a permit to construct a new driveway or modify or chanLe <br /> the use of an existing driveway connected to a Town Road. <br /> Names: Owner /9/).-----/i r k,en I <br /> _ <br /> Address /42:&? „Q-ci, <br /> Telephone •=12e1"2..- ;3rzli _ <br /> Location <br /> . Town Road Name P-ceyike <br /> 2. Distance and direction from nearest intey:ction "?;0 . _ <br /> 3. Side of Town Road (circle one) South East <br /> Fire Number or Lot Number/Subdivision Name <br /> 7.7 <br /> 5. Location of new driveway is teet (circle one) North Eist <br /> of nearest driveway. Fire Number <br /> • O. Location of new driveway is on (circle one) same opposite side as newest driven <br /> Proposed Access Use <br /> • <br /> Y- Residential, Number of dwelling units <br /> Commercial, Number of Paiting Spaces <br /> Agricultural <br /> Other <br /> Construction Material <br /> Concrete <br /> Asphalt • <br /> Gravel <br /> • Other (explain) <br /> • <br /> Culvert Size Length Type <br /> Not required (explain) <br /> • _ <br /> Applicant hasrap -qed the attached checklist and agrees to install the drivewa) in aceordanee <br /> „ <br /> • with the pro (ision of cpie checklist and the Town of Roxbury Driveway P Ordinance <br /> rumance <br /> Signed <br /> Date —/S <br /> Approved by the Town of Roxbury <br /> lc / <br />