NEW
New
(269) 469-1011 Fax (269) 469-6711 Parcel No. __________________________
Hearing Date ________________________
Planning Commission Action___________
___________________________________
___________________________________
Permit No. __________________________
Date Issued _________________________
PRIVATE ROAD APPLICATION
IDENTIFICATION
OWNER: CONSTRUCTION LOCATION:
Name ____________________________ Name ____________________________
Address __________________________ Address __________________________
City/State/Zip ______________________ City/State/Zip ______________________
Home Phone _______________________ Business Phone _____________________
Legal Description ________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Written description of the development to be served by the
________________________________________________________________________
________________________________________________________________________
APPLICATION
REQUIREMENTS
_________ 10 copies of a site plan, drawn to scale (at least 1”=100’), prepared by a registered engineer, showing a general location sketch, the precise location, grade, route, elevation, dimensions, and design of the private road and any proposed extensions thereto, existing and proposed curb cuts, and the location and distance to any public road which the private road is to intersect.
_________ A survey of the right-of-way by a registered land surveyor, together with surveys for each parcel to be served by the Private Road.
_________ The location of all public utilities, including, but not limited to, water, sewer, telephone, gas, electricity, and television cable to be located within the Private Road easement or within twenty feet of either side thereof.
_________ The location of any lakes, streams, wetlands, drains, and slopes (over 20%) within the proposed easement or within 100 feet thereof.
_________ The location of any other buildings and structures located, or to be located, within 100 feet of the Private Road right-of-way.
Signed: ________________________________ Date: _________________________
Applicant