TOWN OF GOSHEN
APPLICATION FOR DRIVEWAY PERMIT
NON-TOWN MAINTAINED ROADS
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 The plans, as filed and approved must be adhered to unless superseded by a new permit.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.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
OWNERS NAME____________________________________________________________ PHONE #(area code) _________________________________________
ADDRESS ________________________________________________________________________________________________________________________________
CITY ___________________________________________________________________________________________________ STATE _________ ZIP ____________________
DATE ______________________________________________________ _______________________________________________________
SIGNATURE OF HOMEOWNER
CONTRACTORS NAME _______________________________________________________ PHONE # (area code) ____________________________________________________
ADDRESS ________________________________________________________________________________________________________________________________________
CITY_________________________________________________________________________________________________ STATE _________ ZIP _______________________
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 ______________________________
This Application for a Driveway Permit is approved:
DATE ____________________________________________________________ ______________________________________________________________ ZONING ENFORCEMENT OFFICER
INSPECTION OF COMPLETED DRIVEWAY IS APPROVED:
DATE ____________________________________________________________ _________________________________________________________________ PUBLIC WORKS SUPERVISOR
| 
