Fillable APPLICATION DRIVEWAY APPROACH PERMIT (Asphalt or Concrete) For (Village of Caledonia)

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APPLICATION DRIVEWAY APPROACH PERMIT (Asphalt or Concrete) For (Village of Caledonia)

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VILLAGE OF CALEDONIA
5043Chester Lane
Racine, WI 53402
262-835-4451
APPLICATION
FAX 262-835-2388 FOR VILLAGE USE
Permit Number:
Receipt Number:
Amount of permit:
DRIVEWAY APPROACH PERMIT (Asphalt or Concrete)
For a Driveway Extension into a Public Right-of-Way or
the Installation of Asphalt Shoulders
PERMIT FEE – $75.00 per driveway entrance
additional $105.00 for a concrete driveway
Account Number: 4350
Date Issued:
DATE:
PHONE:
NAME:
ADDRESS:
CONTRACTOR:
DRIVEWAY PERMIT
CONCRETE DRIVEWAY AGREEMENT
PHONE:
PAVED SHOULDER PERMIT
DESCRIPTION OF PROPOSED WORK:
ENGINEERING DEPARTMENT:
APPROVED
BY:
DATE:
WORK NEEDED:
Install drive so as to ensure proper drainage away from all buildings, to ensure natural drainage is not
restricted, and to ensure runoff does not create a problem with abutting properties or icing of the road
right-of-way. Side slopes on drive not to exceed 4:1.
P:\ENGINEER\FORMS\Asphalt Application.doc
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APPLICATION DRIVEWAY APPROACH PERMIT (Asphalt or Concrete) For (Village of Caledonia)

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Completed 20 July 2020

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