Laserfiche WebLink
Application Number Zo IS-.C.- <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 T-6"4\ k- . . Agent (-JCL ' `�, Q--hg L -�. <br /> Address ( <br /> -t '-- <br /> Telephone _ — 'j' ' L, ;. i t^ ` 4 7 <br /> Location j �}; t � <br /> ' <br /> 1. Town Road Name t-1`J 1 ',� L& _,Q_ _ _ <br /> 2. Distance and direction from nearest intersection • <br /> 3. Side of Town Road (circle one) North South East , West _ <br /> 4. Fire Number or Lot Number/Subdivision Name ! - � i�lr; <br /> 5. Location of new driveway is i _ feet (circle one) North :So th East West <br /> of nearest driveway. Fire Nut ber <br /> 6. Location of new driveway is on(circle one) sam opposite 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 /> t Asphalt <br /> `_ Gravel <br /> Other(explain) <br /> Culvert Size /8 " Length .$6 - "Type eo 4,4.s red en.c_ S-7414...Ge"1.1r wl <br /> Not required(explain) 1 #1,'''c'"'` dc.4"`-."r <br /> Applicant has completed the attached checklist and agrees to install the driveway in accordance <br /> with the provisions of the checklist and the Town of Roxbury Driveway Permit Ordinance <br /> Signed ._. Date � <br /> ' &--1 4•-i C <br /> Approved by the Town of Roxbury 411 - _ Date_3__o(5-- <br /> APPROVED <br />