Fillable ROW ACCESS PERMIT/ SITE GRADING INSTRUCTION SHEET PARCEL (Village of Caledonia)

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ROW ACCESS PERMIT/ SITE GRADING INSTRUCTION SHEET PARCEL (Village of Caledonia)

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F:\WORD\HOME\COMMON\ENGINEER\FORMS\ROWForm.doc
VILLAGE OF CALEDONIA
ROW ACCESS PERMIT/
SITE GRADING INSTRUCTION SHEET
PARCEL 004-04-
For Village Use
Permit Number:
Receipt Number:
Account Number:
Approved / Denied
Date Issued:
Name of Applicant:
Phone Number:
(Work)
(Home)
Address of Applicant:
Owner:
Phone Number:
(Work)
(Home)
Highway Access Permit Fee - $100.00
Payment Rcvd.:
Date
By
Rec. #
Culvert Required:
Yes No
Culvert Length (min.):
(Feet)
Culvert Diameter and Type:
Culvert Elevation (Flow Line):
North West
(Feet)
Culvert Elevation (Flow Line):
South East
(Feet)
Note: Flared end Sections will be required on all driveway culverts unless waived in writing by
Village Engineer. Culvert must be installed and driveway built before construction be-
gins, unless temporarily waived in writing by Village Engineer.
Remarks:
Signature of Applicant:
Date:
Permit Granted:
Date:
Village Engineer
------------------------------------------------------------------------------------------------------------------------------
SITE GRADING AND FINISHED YARD GRADE INSTRUCTIONS
Proposed Finished Yard Elevation:
Note: The finished yard elevation shall be the finished elevation around the immediate perime-
ter of the building. The contractor shall be responsible to calculate the depth of footing
excavation which will provide for the above assigned finished yard elevation.
Approval:
Date:
Village Engineer
Remarks:
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ROW ACCESS PERMIT SITE GRADING INSTRUCTION SHEET PARCEL (Village of Caledonia)

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Completed 20 July 2020

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