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Application Number R7 21 - 2 6 - 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 ,F{—Cr (a . Agent )- �,� rr)ES <br /> Address T .E- \� ra,4 <br /> Telephone G Oe• (p4 31 11 C c:=6_ LLIA-1.3c?t I . <br /> Location / <br /> 1. Town Road Name 3-Ehli rt l l.A b -_ 6 <br /> 2. Distance and direction from nearest intersection 5bil E#1/4c 5 A- <br /> 3. Side of Town Road (circle one) North Sour East West <br /> 4. Fire Number or Lot Number/Subdivision Name L ,-- 38 ,.qr-- e-g'� c <br /> 5. Location of new driveway is feet(circle one) North South East West <br /> of nearest driveway. Fire Number C(N."0 <br /> 6. Location of new driveway is on(circle one) same poitse? side as nearest driveway <br /> Proposed Access Use <br /> _ Residential,Number of dwelling units <br /> Commercial, Number of Parking Spaces <br /> Agricultural <br /> '♦ aGt <br /> T Other .. a <br /> Construction Material <br /> Concrete i,„4„4, 5,,,,,:::,4- <br /> , - Asphalt p,l `�_ Gravelffdd 'I., <br /> Other(explain) r <br /> Culvert Size i'gf <br /> i a Length Z W Type CO rr.4 4 ) 11j.cl e) <br /> Not-re ) L13,114 Rltrc•k f.,. a-it," <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 /> Signed ___ -- ---- Date (Q--,(0--2-0-2-) <br /> Approved by the Town of Roxbury Date <br /> u , vu K 2' ' eve d_ j Y-G/ C /#.t.7 !t'/F/ZNccf &L4 ' <br /> lv�ll- rL .1.�� <br /> A/� f f <br /> h a.[�t 1 ai a ......' 11. h1 Cu.)vtri a f 'a 6 ltJ . 'ce 1. . i-d. . <br />