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Curb Cutting

  1. (Street/Box Number & Name of Street)

  2. (FT)

  3. Principle Use of Property:

  4. At Edge of Road

  5. At Property Line

  6. Within Town Way

  7. (Yes or No)

  8. At Edge of Road

  9. At Property Line

  10. Within Town Way

  11. Show proposed entrance locations, width and arrangement; distance between entrance; setback 9from edge of traveled way) of buildings, gasoline pumps, etc.; location of existing culverts, pipes, catch basins or manholes, curbing, gutter, and sidewalks; and the location of proposed culverts, ditches, curbing and sidewalks.

  12. I am duly authorized to execute this application and have reviewed and will comply with the above. I further agree to comply with all requirements of the Entrance Permit and agree to pay any subsequent charges which may become due as a result of my failure to comply with any of the permit requirements of the Right of Way Ordinance.

  13. For Office Use Only

  14. Leave This Blank:

  15. This field is not part of the form submission.