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Town of Oregon <br /> Driveway Permit Application <br /> Name and Address of Property"Owner" &,n r IVEctso6r <br /> 7,9 <br /> L."rt <br /> Or Agent for Property Owner(if applicable): <br /> Phone Number of Owner Agent <br /> Location: side of Town Road .5 y„ ,zr gp located tc, mild <br /> from Co)tu7 Ji , in Section /7 Town of Oregon. <br /> Conditions <br /> Width of driveway � in feet. Center of driveway from property line: 2 2 feet. <br /> No drainage culvert needed. OR 10'` <br /> Drainage culvert needed. Size: Length feet <br /> Diameter inches -rmav'r <br /> 4 <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 /> �� ,✓o /4 ;pia— 16 ,<m r / .. ° r g r cf J <br /> •Sre,a ra<dm (f' Ca )Lay <br /> I acknowledge receipt of th Town of Oregon driveway ordinance and conditions of approval: <br /> Signature of Property Owner or Agent Date <br /> Approval <br /> Permit Granted (two signatures required): <br /> T card (, a+ nan tJ r <br /> Date �•3 <br /> c <br /> Town Public Works Date <br /> FOR OFFICE USE ONLY: Date Permit Fee Paid: W/A/A _ Check Number: Receipt Number: <br />