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Design & Construction Specifications - Town of Kernersville

Design & Construction Specifications - Town of Kernersville

Design & Construction Specifications - Town of Kernersville

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DATE:_______________________________TOWN OF KERNERSVILLEAPPLICATION FOR DRIVEWAY PERMITPROPERTY IDENTIFICATION: TAX BLOCK____________, TAX LOT____________;LOCATION OF PROPERTY (ADDRESS):______________________________________DRIVEWAY WIDTH (1)_____FT. (2)_____FT. (3)_____FT. (4)_____FT.1) I, the undersigned property owner, request permission to construct the driveway(s) on publicright-<strong>of</strong>-way at the above location.2) I agree to construct and maintain the driveway(s) in conformance with the current " <strong>Town</strong> <strong>of</strong><strong>Kernersville</strong> <strong>Design</strong> and <strong>Construction</strong> <strong>Specifications</strong> Manual" on file with the TOWN OFKERNERSVILLE ENGINEERING DEPARTMENT.3) I agree to construct and maintain all driveway(s) in a safe manner so as not to interfere with orendanger the traveling public.4) I agree that no signs or objects will be placed on or over the public right-<strong>of</strong>-way.5) I agree that the driveway(s) will be constructed as shown on the attached sheet.6) I agree that if any future improvements to the street become necessary, the portion <strong>of</strong> driveway(s)located in public right-<strong>of</strong>-way will be considered the property <strong>of</strong> the TOWN OF KERNERSVILLE, andI will not be entitled to reimbursement or have any claim for present expenditures for drivewayconstruction.7) I agree that this permit becomes void if construction <strong>of</strong> the driveway(s) is not completed within six (6)months from the date it was issued.8) I agree that this permit will be on site during construction.******************************************************************************PROPERTY OWNERNAME:______________________________SIGNATURE:_________________________ADDRESS:________________________________________________________________TELEPHONE NO.:_____________________APPLICANTNAME:_____________________________SIGNATURE________________________ADDRESS:______________________________________________________________TELEPHONE NO.:____________________******************************************************************************APPROVED:_________________________________ ______________________ ___________________SIGNATURE TITLE DATECOMMENTS:______________________________________________________________________________________________________________________________________________________________________________________________________________________________Contact <strong>Construction</strong> Services Section, Public Works Department (996-6916), for inspection, prior to any finalconstruction.Inspected By:Signature Title DateREPRODUCIBLE FORM

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