Application-Permit 7-15-05 Redlined.Cbh (00123365.DOC;1)

INSTRUCTIONS FOR APPLICATION/PERMIT FOR DRIVEWAY By following these instructions, you will increase the efficiency and speed of processing your application.  Please type or print neatly in ink the required information on the application.  Two copies of this application must be prepared by applicant.  Retain one copy of the completed application for your records, and send the copy with original signature to the Clerk of the Town of Lowville or to the Chairperson of the Lowville Plan Commission.

1. Applicant(s) Name - Provide full name of the property owner(s) or person(s) requesting the permit.

2. Applicant(s) Mailing Address - Provide street name and/or P.O. Box number, city, state, and ZIP code information. This address information is used to return application/permit to applicant.

3. Applicant(s) Home Phone and Preferred Times/Days: Provide a telephone number, including area code. Note if there are certain times of the day and/or days of the week that are more convenient to contact you.

4. Name of Road to which Driveway will Connect - Provide the number of the state highway or the letter or name of the county/town road to which the driveway will connect. Provide all numbers, letters and names if two or more highways or county/town roads run concurrently.

5. Completion date - Provide the anticipated date of completion of the driveway.

6. Legal Description - This information can be obtained from the property tax bill or by contacting the appropriate local township, village, city, or county clerk. If applicable, provide the Fire Number if one has been assigned to the property, or provide it as soon the number is assigned. In addition, provide the Property Tax ID Number.

7. Type of Driveway Activity - Check one of the boxes, using the following definitions. • Construct New: to construct a new driveway, or relocate an existing unpermitted driveway. Note: "Unpermitted" means not having an approved permit from the Town of Lowville. • Alter Existing: to physically modify, or change the use of, any existing driveway with an approved Town of Lowville permit whose location will not change. Physical activities include paving, widening, replacing a culvert, etc. "Change the use of” means going from one type of land use to another - for example, from residential to commercial, or from single residential to multiple residential. • Relocate Existing: to change the location of any driveway that has an approved Town of Lowville permit. • Remove Existing: to remove any driveway that has an approved Town of Lowville permit. • 8. How is the property currently zoned? Provide current zone classification. This information can be obtained from the Town Clerk.

9. How many existing driveways does the property currently have? Provide the appropriate number.

10. If you are aware of any future plan to change the zoning of land use of the property, list the type of future zoning district desired and explain the reason for the planned change. If you have knowledge of this information, you must provide it and briefly explain the circumstances regarding the change. For example, “construct new house”.

11. If there are any access easements or driveway sharing agreements across the property, whether recorded or unrecorded, list the names of the easement holder(s) and/or shared user(s). Access restrictions and/or driveway sharing agreements may be contained in a subdivision plat, certified survey map, deed, access covenant, agreement, plat, map, easement, or existing permit. These documents should be carefully reviewed when applying for a driveway permit. An access easement is typically defined as granting another party the right of vehicular access across a property. Provide all appropriate names of those having an easement and/or a sharing agreement across the property which will be accessed by the proposed driveway.

12. What use will the proposed driveway serve? Check the appropriate box described by the following definitions:  Rural Residential: a private home(s) located outside of the corporate limits of a village or city;  Agricultural: a farm residence, building or field. This includes recreational and hunting use;  Recreational: land developed which invites any active or passive recreational activities, such as community parks, nature study areas, ball parks, campgrounds and public hunting grounds.  Single Family Dwelling: a residence housing only one family.  Multiple family dwelling: a residence housing more than one family.  Commercial: land and/or building(s) utilized for diversified business types including non-retail commercial Type of driveway: indicate whether the driveway will access a house, out building, field or other. If other, indicate what the driveway will access.

13. The proposed driveway will be 300 feet from the nearest intersection and 75 feet from the nearest existing driveway. These distances can be estimated by driving (0.1 mile equals 528 feet). The other driveway may be on either side of the highway or road. See paragraphs applicable provisions of the Lowville Driveway Ordinance.

1 TOWN OF LOWVILLE PLAN COMMISSION

DRIVEWAY APPLICATION AND PERMIT APPROVAL/DENIAL  See conditions on page 3 and instructions on page 1.  Attach extra sheets if space on this form is insufficient to  Please type or print in ink. provide a complete answer.

APPLICATION

1. Applicant(s) Name(s) 2. Applicant(s) Mailing Address - Street, P. O. Box, City, State, ZIP

3. Applicant(s) Home Phone and Preferred Times/Days (______) ______-______

DRIVEWAY 4. Name of Road to which Driveway Will Connect 5. Completion Date: LOCATION INFORMATION 6. Legal Description: 7. Type of Driveway Activity (check one) Located in the ______Quarter of the ______Quarter, Section ______, Construct New Driveway Town 11 North, Range 10 East. Alter Existing Driveway Relocate Existing Driveway Fire Number (if any): ______Remove Existing Driveway Property Tax ID Number ______Permit Existing Driveway 8. How is the property currently zoned? 9. How many existing driveways does the property currently have? ______10. If you are aware of any future plan to change the zoning or land use of the property, list the type of future zoning district desired and explain the reason for the planned change.

11. If there are any access easements or driveway sharing agreements across the property, whether recorded or unrecorded, list the name(s) of the easement holder(s) and/or shared user(s). If so, please attach appropriate copies to this Application.

12. What use will the proposed driveway serve? (Check one in each column) 13. The proposed driveway will be ______feet from the nearest Zone District Type of Driveway intersection and ______feet from the nearest existing driveway. Rural Residential House Agricultural Out Building Recreational Field Single family dwelling Other ______Multiple family dwelling ______Commercial ______I HEREBY CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND CORRECT. I understand that the construction and maintenance of the driveway shall be my responsibility. It is further understood and agreed that approval is subject to my full compliance with the pertinent statutes, as well as any codes, rules, regulations, ordinances and permit requirements of other jurisdictions. I agree to comply with all permit provisions, superimposed notes and detail drawings which may be required by the Town of Lowville. Any alteration of this form is prohibited. I understand that I have the right to appeal any decision to deny a driveway permit as allowed by the Town of Lowville Driveway Ordinance. I further agree to notify the Town Clerk and Building Inspector 48 hours prior to starting the work on this driveway.

______Date: ______Applicant Signature

For official use only PERMIT APPROVAL/DENIAL For official use only PERMIT IS APPROVED. THIS PERMIT IS REVOCABLE. PERMIT IS DENIED PERMIT NUMBER: ______See attachment for explanation. Permit fee has been paid. Special conditions apply. See attachment for explanation.

Dated this ______day of ______, 200______.

LOWVILLE PLAN COMMISSION

______(Name and Title)

2 CONDITIONS OF ISSUANCE

1. The Application and Permit processes and the construction of a driveway shall meet all requirements of the Town of Lowville Driveway Ordinance.

2. The Applicant(s) indicated on page one represent(s) all parties in interest, and any driveway or approach constructed by or for him/her is for the purpose of providing driveway to property, and not for the purpose of parking or servicing vehicles, or for advertising, storage, or merchandising of goods on the public roadway.

3. Except in cases where the indicated driveway may be constructed by forces acting on behalf of the State in relation to a highway construction or reconstruction project, the applicant shall furnish all materials, do all work, and pay all costs in connection with the construction of the driveway and its appurtenances on the right-of- way. Materials used and the type and character of the work shall be suitable and appropriate for its intended purpose, and the type of construction shall be as designated and subject to the approval of the Town of Lowville. The applicant shall make the installation without jeopardy to or interference with traffic using the public roadway. Public roadway surfaces, shoulders, ditches, and vegetation disturbed, including drainage appurtenances, guardrail, signs, electric conduits/cables, etc. (collectively: facilities), shall be restored to at least pre-existing conditions. In every instance, the subsequent maintenance of the driveway and its appurtenances within the limits of the public roadway shall be the responsibility of the permittee, who shall be obligated to pay all costs and accomplish all works necessary in relation to said maintenance. Any highway facilities disturbed by operations relating to maintenance of the driveway shall be promptly restored by the permittee to the satisfaction of the Town of Lowville. No survey markers shall be disturbed.

4. The permittee must receive written approval from the Town of Lowville prior to changing the type of use (item 8 on page 1) granted herein. The Town of Lowville will evaluate all potential public roadway impacts that could arise from the proposed change and, therefore, cannot guarantee that the change will be approved.

5. No revisions or additions shall be made to the driveway or its appurtenances on the right-of-way without the written permission of the Town of Lowville.

6. The Town of Lowville reserves the right to make such changes, additions, repairs, relocations and removals allowed by law to the driveway or its appurtenances on the public roadway as may at any time be considered necessary to facilitate the relocation, reconstruction, widening, and maintaining of the public roadway or to provide proper protection to life and property on or adjacent to the public roadway

7. The permittee, successors or assigns agree to hold harmless the Town of Lowville and its duly appointed agents and employees against any action for personal injury or property damage sustained by reason of the exercise of this permit or the driveway.

8. The Town of Lowville does not assume any responsibility for the removal or clearance of snow, ice or sleet, or the opening of windrows of such material upon any portion of any driveway or entrance along any public roadway, even though snow, ice or sleet is deposited or windrowed on said driveway or entrance by its authorized representative engaged in normal winter maintenance operations.

9. The Town of Lowville requires the permittee to assure that proper erosion control and storm water management measures be implemented at all times during work operations. The permittee shall also be responsible for providing erosion control and storm water management measures to protect all restored areas upon completion of the driveway until the replacement vegetation achieves sustained growth.

10. ROCK, BITUMINOUS, CONCRETE, TIMBER OR OTHER EMBANKMENT RETENTION OR DRIVEWAY MARKING TREATMENTS ARE PROHIBITED IN THE PUBLIC ROADWAY.

11. If the permitted work is not finished by the required date, the applicant shall not complete the work unless authorized through a subsequent permit or an approved time extension. All other obligations and responsibilities of the applicant under this permit regarding the permitted work and facilities and associated operations shall remain in full force and effect. Accomplishment of the permitted work or any part thereof shall verify agreement by the applicant to conform to this permit and to be bound by all its requirements, provisions, and obligations.

Additional permit provisions, if necessary, are listed below and/or attached.