Village of Arlington

VILLAGE OF ARLINGTON DRIVEWAY AND SIDEWALK APPLICATION

Fee $ 25.00

I own the property at ______in the Village of Arlington and I wish to (circle one) construct, repair, enlarge or replace my driveway.

Type of material used (asphalt, concrete, etc.): ______Width and length of driveway section covered under this permit: ______

____ I have to replace the sidewalk crossing the driveway at the same time, which will be replaced to the specifications outlined in Village ordinances. ___ There is no sidewalk replacement.

___ I will be doing the work myself. ___ The Company doing the work is ______Company Phone: ______

Please read and initial to acknowledge the following items _____ I represent all parties in interest, and that such proposed driveway is for the bona fide purpose of securing access to my property and not for the purpose of parking or servicing vehicles, advertising, storage or merchandising of goods within the dedicated portion of the Village street, or for any other purpose. _____ The Village, notwithstanding the construction of such driveway, reserves the right to make any changes, additions, repairs or relocations within the dedicated portion of the Village street at any time, including relocation, reconstruction, widening and maintaining the street without compensating the owner of such private driveway for the damage or destruction of such private roadway. _____ I, my successors and assigns, agree to indemnify and hold harmless the Village of Arlington, its officials, officers, agents or employees, against any claim or any cause of action for personal injury or property damage sustained by reason of the exercise of such permit. _____ The Village does not assume any responsibility for the removal or clearance of show, ice or sleet or the opening of any windrows of such material upon such portion of such driveway within the dedicated portion of the Village street.

Please fill out the following information (please include any additional information on the rear of this application):

Name ______Signature ______

Address ______

Date submitted: ______

Approved/Denied (circle one): ______Date ______Village Clerk