Laserfiche WebLink
p ' ( V .24/54 2 SO. <br /> oo <br /> • 12,24 d 2'1409 42500. <br /> Application Number J - <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 /> c. <br /> Names: O'\ner 3aY\A4t`a t orv� RA,-4 het��lyd,t <br /> Address I E a 4- Vi las Ave <br /> mad,soot WI. 53411 <br /> Telephoi . (Dog" 3 4 3. 3 9 0$ <br /> Location <br /> I. Town Road Name `Jc)h o e. p 'Roc, <br /> 2. Distance and direction from nearest intersection 38"4•5 . a .t <br /> vv\ Scoe v <br /> 3, Side of Town Road (circle one) North Sou:'. �;t « (� <br /> 4. Fire Number or Lot Number/Subdivision Nan tot t-{ <br /> 5. Location of new driveway is '�5 feet(circle one) North South East v, <br /> of nearest driveway. Fire Number 842 3.. <br /> 6. Location of new driveway is on (circle one) same opposite side as nearest driveway <br /> Proposed Access Use <br /> •./ Residential, Number of dwelling uni::, C <br /> Commercial, Number of Parking Spak. <br /> Agricultural <br /> Other <br /> Construction Material <br /> Concrete <br /> Asphalt <br /> ✓ Gravel <br /> Other(explain) <br /> Culvert Size Length l y pe <br /> Not required (explain) no._‘t4,1 _ <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 /> Sid ur.i Date <br /> a "30/zQ 2- <br /> (t)© pproved by the Town of Roxbury `"` �-- Date <br />