Town of Barnes

Town of Barnes

Application for Private Driveway/Road – Permit

Date of Application: ______

Applicant(s) ______

(Property Owner(s)) (Name) (Name)

______

(Address) (Address)

______

(City/Town), (St) (Zip Code) (City/Town), (St) (Zip Code)

______

(Telephone Number) (Telephone Number)

Tax Parcel No.______Fire # if any:______

Town Road Name: ______

Application Permit to construct: ____Private Driveway ____Private Road

Construction Start Date:______Complete Date:______

Contractor or Person performing construction work:

______

(Name) (Address) (City/St/Zip) (Tel) #

Permit FEE: $25.00 Date Received: ______By: ______

Initial Inspection : Approved/Disapproved ______Date:______

(Circle one) (Town of Barnes Representative)

Final Inspection: Approved/Disapproved ______Date:______

(Circle one) (Town of Barnes Representative)

(Use back page for sketch)

Property lines, driveway placement, Town Road