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No Work May Commence Until Entrance is approved by the Road Commissioner or
his/her designee
Date
Received: _____________
Fee: _____________
APPLICATION FOR DRIVEWAY/ENTRANCE PERMIT
TOWN OF
PHONE/FAX: 375-8881
Application is hereby made to
construct, change location, grade or use served by a driveway or entrance to
property or to provide utilities (i.e., underground electrical, telephone or
gas), or make changes within a Town of Wales road right-of-way in accordance
with the Road Ordinance of the Town of Wales, Maine.
THE OWNER/APPLICANT HEREBY AGREES:
1) To construct
and maintain said driveway approach in accordance with the Town of
2) To pay for
any culverts and/or other drainage which may initially be
necessary for drainage. To ensure
that the culvert installation is in accordance with the Town of
3) Owner/applicant
shall, will and truly pay all damages, fines and penalties for which he shall
become liable, and shall indemnify and save harmless the Town of Wales against
all suits, claims, damages and proceedings of every kind, arising out of the
construction and maintenance of said driveway approach or change within the
road right-of-way, including snow removal.
4) The owner/applicant will notify Dig-Safe not less than 72 hours in advance of proposed construction (Toll-free 1-888-344-7233 or 1-888-DIG-SAFE).
__________________ ________________________________ ________________________________
Date filed Signature of Owner Signature of Applicant
□ By signing and checking this box I hereby certify that
I have been granted permission from the property owner to act in their behalf.
---------------------------------------------------------------------------------------------------------------------------------------------------
Do Not Complete – To be filled out by
Road Commissioner or his/her agent.
Additional
specifications/changes required to work plan:
__________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Culvert
Size: ______ diameter ______ length. Culvert cover: ________ inches. □ Waiver granted
Culvert
installation must meet town standards and be inspected for compliance.
Approved: ____
Denied: ____ If denied, reason:
________________________________________________________
_______________________________________________________________________________________________
Approved/Denied
By:
______________________________________________ Date: __________________________
Inspected
By: _____________________________________________________ Date:
_________________________
Completed
Entrance/Culvert Installation Approved By: __________________________________________________
Date: _________________________________
After approval and acceptance, the Town
of
Land
Owner’s Name:
_____________________________________________ Phone:
______________________ Mailing
Address: _____________________________________________________________________________ Applicant
or Agent’s Name: _________________________________________ Phone:
______________________ Mailing
Address:
_____________________________________________________________________________ Other Contact
information: _____________________________ Work# _______________
Cell#_______________ |
|
Directions
to property:
_________________________________________________________________________ ___________________________________________________________________________________________ Route
#: ____________________________ Road Name:
_____________________________________________ Nearest
Intersection: _______________________________________ Distance From (in
10ths/mile) ____________ Nearest
Utility Pole#: _____________ Map and Proposed Location of Driveway/Entrance shall be
staked and flagged by applicant. |
|
Proposed Driveway/Entrance Purpose: □ Single Family Residence □ Home
Business □ Commercial/Industrial □
Subdivision/Development □ Multi-family (< than 5 units) □
Multifamily (> than 5 units) □ Retail □ Office □ School □ □ Other (please describe)
________________________________________________________________________ #
employees/day _______ # customers/day
_______ Busiest time of day _____________ # of Lots _________ ------------------------------------------------------------------------------------------------------------------------------------------------ Driveway/Entrance
width (feet): ___________ Surface Type (i.e., gravel/paved):
______________________ Does
this property have an existing access? ___ Yes ___ No
(if yes please indicate type of
change below) □ Change in use
□ Physical
modification/other change within a town road right-of-way Please Describe: _________________________________________________________________________________ Culvert
Installation Specifications: ___________________________________________________________________ _______________________________________________________________________________________________ Additional Information:
_____________________________________________________________________________ |
|
Construction
expected to begin (date) _________________ and be completed on (date)
________________ Contractor
Name/Address: _______________________________________________________________ Contractor
contact name: ______________________________________ Phone#: ____________________ |
Site Sketch (or attach Site Plan or blueprints) Draw Arrow
to Show North
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