APPENDIX A: DRIVEWAY PERMIT APPLICATION FORM

1.   Applicant/Permitee:                                                                                                             
            Name            Address

                                                                                                                     
            Signature

2.   Driveway Location:                                                                                                            
            Street Address         Subdivision Lot #

3.   Driveway Type:                                                                
         Residential       Commercial      Industrial

4.   Special Conditions:                                                                                                           

5.   Inspections:                                                                                                                 
         Initial         Erosion Control   Drainage      Final

                                                                                                                       
         Bond Setting      Bond Release      Reinspection(s)   Other

7.   Fire Chief Approval (if required):                                                                                      

8.   Plans:                                                               or provide Sketch Plan:
      Title and Date of Proposed Site Plan

9.   Improvement Location Survey Plan:                                                                                   
                        Date of Map

10.    Variance Required:                                    Variance Granted:                                            

11.   Bond Release:                                                                                                                 
         Authorized By:                Date

12.   Approvals:                                                                                     
         As To Location   Const. Entrance   Final

(Ord. passed 12-8-1997; Ord. passed 10-5-2000)