Town of Washburn

Driveway Permit Application

 

Applicant’s Name ___________________________________________ Date _____________

Applicant’s Address ________________________________________ Phone _____________

Property Owner’s Name ________________________________________________________

Address of proposed driveway ___________________________________________________

Section _______ Town _______ Range _______ Quarter/Quarter ______________________

The driveway will provide access to State Highway __ County Highway ___ Town Road ___

Proposed Land Use of property ___________________________________________________

Specify the erosion control procedures to be utilized ___________________________________

Specify the proposed roadbed base, including depths and types of materials ________________

 

Check the box for the type of driveway proposed: □ Permanent □ Temporary

Check box if permanent driveway is shared by two or more parcels under different ownership: □

Signature of Applicant

  • Provide a sketch on the back of this application of the proposed driveway, including grade, slope, width and length. Indicate turnoffs, if required, and the dead end turn-around.

 

Specifications:

 

TO BE COMPLETED BY TOWN

□ Shared Driveway: No Fee

□ Application Fee Paid □ Temporary Driveway Deposit Paid □ Deposit Returned

($20.00) ($400.00)

Initial & Date: __________________ _________________________ _________________

 

A culvert (will, will not) be required. If required, a minimum diameter of ______ inches.

The above has been (approved, denied) by the Town of Washburn Board on the

_______ day of ____________________, ________________.

 

____________________________________ Chairman

____________________________________ Supervisor

____________________________________ Supervisor