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Town of Oregon <br /> Driveway Permit Application <br /> Name and Address of Property "Owner" / h Dlv f) UG. 9 .3 <br /> I11 I J A i/ I �I <br /> w / ,P <br /> Or Agent for Property Owner (if applicable): <br /> Phone Number of Owner baF_ 2-0 9 7 Agent A (92/e/ k_C2 <br /> Location: ‘ 7i-) side of Tow Road 2- Dkn located °y3 miles <br /> from �'1 i 1 , in Section /i Town of Oregon. <br /> 214 Conditions <br /> Width of driveway -2`t in feet. Center of driveway from property line: SIS::) feet. <br /> foxy. Qe lot(k"R. <br /> No drainage culvert needed. OR <br /> Drainage culvert needed. Size: Length 2.44 feet. <br /> Diameter illiZIMPOetft• <br /> r r <br /> Permit Fee $100; Field Drive $50.00; Re-inspection Fee $50.00 <br /> Other requirements: Inspection of proposed drive must be done 48 hours prior to beginning of <br /> excavation work. <br /> I acknowledge receipt of the Town of Oregon driveway ordinance and conditions of approval: <br /> I <br /> Signature of Prop: y Owner or Agent Date <br /> Approval <br /> Permit Granted (two signatures required): <br /> S <br /> Y <br /> Town iard hairman Date <br /> fve, ,/co,„ <br /> Town Public Work Date <br /> FOR OFFICE USE ONLY: Date Permit Fee Paid: /00 -Check Number: C--g/(_ Receipt Number: <br />