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2. Applicant Information
3. Driveway Permit Fee:
   $25.00 (if submitting with a new house permit, the two fees can be paid together with one check/cash)
5. Applicant Name:
6. Email Address:
8. Address:
9. City:
11. State:
12. Zip Code:
13. Phone Number:
17. Property Location & Information
19. Address:
21. City:
22. State:
23. Zip Code:
25. Subdivision:
26. Lot Number:
30. Installations
32. Installation Description:

    1. New Access
    2. Existing Upgrade
    3. Non-Curb & Gutter
33. Non-Curb & Gutter - Distance from Utility Boxes, Fire Hydrants, Catch Basin:
    Minimum 8 feet.
37. Piping
39. Culvert Pipe:

    1. Steel
    2. Concrete
    3. Other
40. Pipe Length:
    Minimum 30 feet.
44. Driveway
46. Driveway Width:
50. Drive Apron & Intersection
52. Drive Apron Material:

    1. Concrete
    2. Pavers
    3. Asphalt
    4. Gravel
53. Intersection:

    1. N/A
    2. Minor
    3. Major
54. Intersection Distance:
    Minimum 50 feet minor, 200 feet major.
58. Applicant Signature:
59. Date:
    Date:
Leave This Blank:


60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit

* indicates a required field