TOWN OF GOSHEN
APPLICATION FOR DRIVEWAY PERMIT
PERMIT # ___________________________ HOUSE #____________________________
LOCATION LOT # ____________________________ STREET ______________________________
TO: BOARD OF SELECTMEN, TOWN OF GOSHEN, GOSHEN, CONNECTICUT 06756
1. This application is required by a Goshen Ordinance effective 6/16/2002. A Copy of the Ordinance is on file with the Town Clerk. A copy is attached.
2. As per SECTION III – 3.2 of the Town Ordinance, (2) two sets of PLOT PLANS must be submitted with this application and must be of sufficient detail to show all the information that is required by this Ordinance. The plans, as filed and approved must be adhered to unless superseded by a new permit. One copy of the plans will be returned to the applicant with construction requirements. The second copy will be placed on file with the Building Official to be used with the application for the building permit.
3. It is the responsibility of the owner or his agent to design the driveway and to plan for the proper construction elevation. This is to protect the property, for which the permit is issued, from all water that may flow from adjacent Town highways or rights-of-way and to ensure that no water flows from the driveway onto the highway.
4. My signature below certifies that I have read and understand the provisions of the Ordinance and agree to comply with those provisions.
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OWNERS NAME__________________________________________________ PHONE #(area code)___________________________________________
ADDRESS ___________________________________________________________________________________________________________________
CITY ______________________________________________________________________________________ STATE ___________ ZIP ______________
DATE ___________________________________________________ ________________________________________________________
SIGNATURE OF HOMEOWNER
CONTRACTORS NAME _________________________________________________ PHONE # (area code) _______________________________________
ADDRESS ________________________________________________________________________________________________________________________________
CITY ____________________________________________________________________________________ STATE _______________ ZIP ______________________
DATE________________________________________________________ _________________________________________________________________
SIGNATURE OF CONTRACTOR
CALL BEFORE YOU DIG # _______________________________________________PERMIT EXPIRATION DATE _______________________________________________
This Application for a Driveway Permit is approved:
DATE _____________________________________________________ _________________________________________________________________
PUBLIC WORKS SUPERVISOR
FEE RECEIVED DATE_______________________________________________FEE AMOUNT ______________ PAYEE _________________________________________
PIPE REQUIRED_____________________________________________________________FLARED ENDS ____________________________________________________
This Application for a Driveway Permit is approved:
DATE ___________________________________________________ ______________________________________________________________
ZONING ENFORCEMENT OFFICER
INSPECTION OF COMPLETED DRIVEWAY IS APPROVED:
DATE ___________________________________________________ ______________________________________________________________
PUBLIC WORKS SUPERVISOR
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