Laserfiche WebLink
, <br /> Application Number R T 2_1- j Q D <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— 1 t1E it Co. Agenti- (��.,.� rNL <br /> �S <br /> Address i --r vie_ST C7wwa 'Sri-- <br /> r <br /> Telephone �_ _ — - <br /> Location <br /> 1. Town Road Name 1/4-i 144-",411— (---1:1"1C- <br /> 2. Distance and direction from nearest 'I ersection_ <br /> 3. Side of Town Road(circle one) North South East West <br /> 4. Fire Number or Lot Number/Subdivision Name vanommt. 3- B 4- -e-L>s <br /> 5. Location of new driveway is I 10/ feet(circle one) North South East cep <br /> of nearest driveway. Fire Number a S <br /> 6. Location of new driveway is on (circle onesame pposite side as nearest driveway <br /> Proposed Access Use <br /> XResidential,Number of dwelling units 1_ <br /> C) I <br /> Commercial,Number of Parking Spaces <br /> Agricultural <br /> Other <br /> Construction Material *S*9:i °49\C3**** 1 <br /> ____X__. Concrete <br /> X Asphalt <br /> Gravel <br /> Other(explain) <br /> Culvert Size i 8' Length 2.L{' Type are 44.4..,(/ 111,1-41 "''4reQ e.,.S e t� <br /> Not required(explain) lin..r .6e ,9 t S •� V c .....v--t- <br /> Applicant <br /> ....-cApplicant 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 /> lk <br /> Signed i _ _cs Date S 2-0.2—iApproved by the Town of Roxbury fAIM Date 6//8 24 <br /> . / ii ,Ii <br /> 2417-trel, ihv.6Q. “-•r-c <br />