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TOWN OF ROXBURY DRIVEWAY PERMIT APPLICATION <br /> (To be completed along withia erosion control plans See Driveway Ordinance 2001-A) <br /> //Site_end <br /> APPLICANT <br /> Name <br /> Address S . .S 7-- ,r iti 28 <br /> Telephone (Day) Gy,3 SO61 . (Evening) 5106 / <br /> LOCATION <br /> D6 �L go l88 Street,Road,Highway etc. <br /> (N ' )from Road, located(S E.W) of MacJ Road <br /> in the 1 ` quarter of the SLR i/ 7 <br /> �� /� q quarter of Section <br /> in the Town of Roxbury. Plat I N-- ' 7 CSM# <br /> REQUIREMENTS E-5 /S7-J)J( , 7 J VE VV A Y <br /> Centerline,of driveway to be feet (N S E W) of the (N S E W) property line. <br /> Surface width of driveway to be a minimum of feet, with a .foot subgrade. <br /> Culvert: Length feet Diameter inches with Wis. DOT apron endwalls <br /> No Culvert required: Engineer's plan required ( YES) (NO) <br /> CONDITIONS <br /> You are required to contact the Town Engineer(MEI)at 608-643-5329 at least two working <br /> days before starting construction. Refer to Roxbury Driveway Permit Ordinance 2001-A for <br /> construction specifications. Contact MEI if you have specific driveway construction questions. <br /> Upon completion, note the Town Engineer within 30 days to schedule a driveway inspection. <br /> This permit expires one year after the date approved by the Town Board. If construction is not <br /> completed within one year of issue, the applicant must apply for a renewal driveway permit. <br /> APPLICATION FEE,PERFORMANCE BOND & ENGINEERING/INSPECTION COSTS <br /> The application fee to construct or relocate a driveway is $250, payable to the Town of Roxbury at <br /> time of approval. A performance bond of at least $2,500 (based on driveway length) is also due in <br /> the form of a check made payable to the Town of Roxbury. The bond amount will be returned after <br /> the Town Engineer inspects & approves the finished driveway and all Town engineering& <br /> inspection costs are fully reimbursed by the applicant. <br /> Granted By: Date: 2 <br /> Town of Roxbury <br />