RESIDENTIAL
NEW OR ADDITION
COMMERICAL
NEW OR ADDITION
OTHER WORK
TOTAL
DRIVEWAY PERMIT APPLICATION
COMMERCIAL
INDUSTRIAL
OTHER
EXISTING STRUCTURE
NEW STRUCTURE
AGREEMENT
I, the undersigned property owner/agent, request access and permission to construct driveway(s) on the public right-of-way at
the above location. I agree to construct and maintain the driveway(s) in absolute conformance with the Town's specifications
and standards as adopted by the Town Council of the Town of Clayton. I agree that no signs or objects will be placed on or
over the public right-of-way. I agree that the driveway(s) will be constructed as shown on the attached plans or drawings. I
agree that if any future improvements for the roadway become necessary, the portion of driveway(s) located on public right-
of-way will be considered the property of the Town of Clayton, and I will not be entitled to reimbursement or have any claim
for such. I agree that this permit becomes void if construction of driveway(s) is not completed within the time specified
below. I agree to pay the applicable inspection fee. The inspection fee will be reimbursed if application is denied. I agree to
construct and maintain the driveway(s) in a safe manner so as not to interfere with or endanger public travel. I agree to
provide, during construction, proper signage, signal lights, flaggers and other warning devices for the protection of traffic in
conformance with the current "Manual on Uniform Traffic Control Devices for Streets and Highways" (MUTCD). I agree
to indemnify and save harmless the Town of Clayton from all damages and claims for damage that may arise by reason of
this construction. I agree that the Town of Clayton will assume no responsibility for any damages that may be caused to such
facilities, within the street right-of-way limits, in carrying out its construction. If required, I agree to provide a Performance
Bond in the amount specified by the Town of Clayton for any construction proposed on the Town street system.
SIGNATURE
DATE
APPLICANT INFORMATION
NAME
ADDRESS
PHONE NUMBER
OWNER
AGENT
ALT. PHONE NUMBER
PROPERTY USE
PROPERTY LOCATION
ADDRESS
SUBDIVISION
PARCEL ID No. (PIN)
RESIDENTIAL
BUILDING PERMIT No. (if applicable)
Inspections Department • P.O. Box 879 • Clayton, North Carolina 27528 • Office (919)553-5002 • Fax (919)553-1720
www.townofclaytonnc.org
SEE REVERSE SIDE TO COMPLETE DETAILS ABOUT DRIVEWAY
T
OWN OF CLAYTON
Inspections Department
P.O. Box 879
Clayton, North Carolina 27528
Office (919)553-5002
Fax (919)553-1720
DRIVEWAY DETAILS
Driveway width:
Total pipe length to be installed:
Pipe diameter:
RCP Required - 15" minimum diameter
Construction time allowed:
days from initiation of construction
I agree to notify the Town of Clayton Inspections Department prior to beginning work.
Property Owner/Agent
Witness
Name:
Signature:
Date:
Name:
Signature:
Date:
FOR TOWN OF CLAYTON USE ONLY BELOW
Permit Issued by:
Date:
Inspected by:
Date:
Amount Received:
Inspection Satisfactory:
Yes
No
Comments:
Submit two (2) copies of Application along with payment to the Town of Clayton Inspections Department.
ft.
ft.
in.
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome