APPLICATION FOR TOWNSHIP STREET ACCESS PERMIT
(MINIMUM VOLUME USE ONLY)
(Worksheet Use Only)
Address: ___________ Township Index: County Index: (33) |
I hereby make
application to Millcreek Township for a permit to access , a
public street of Millcreek Township, by means of a to service the above property, in connection
with an application for permit to construct or alter a building thereon. The shape of the lot, the location and size
of existing and proposed building and other pertinent information are as set
forth on the application for building permit.
Items set forth hereon. Items
printed in boldface may be completed by the Zoning Officer if not known by the
Applicant.
APPLICANT: REPRESENTATIVE: |
APPLICANT'S ADDRESS: TELEPHONE:
|
ZONING CLASSIFICATION: SUBDIVISION/DEVELOPMENT: |
LOT SIZE: SUBDIVISION/DEVELOPMENT
LOT NUMBER |
BUILDING SIZE: ________
WIDE ________ LONG ________ HIGH AREA: _________SQ. FT.
PROPOSED
USE:________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
ESTIMATEDDAILYTRAFFICVOLUME:______________________________________________________
BASIS OF ESTIMATED
VOLUME:__________________________________________________________
NATURE/SOURCE OF TRAFFIC
VOLUME:__________________________________________________
I certify that the facts
set forth on this application are true and correct. I understand that facts set forth on my
application for building permit and any required occupancy certificate shall be
incorporated into this application. I
certify that access as authorized shall be constructed and maintained in
accordance with the Performance Standards for Minimum Traffic Volume Access, a
copy of which I have received this date.
I understand that any
Date:__________________________
______________________________________________
Applicant's
Signature
--------------------------------------------
(TO BE COMPLETED BY
ZONING OFFICER)
TRAFFIC VOLUME
CLASSIFICATION: BASIS:________________________________
HAS BUILDING PERMIT BEEN
ISSUED? YES NO PERMIT # ____________
APPLICATION IS: APPROVED DENIED
REASON:_________________________________________________________________________________
(Permit cannot be approved except in connection with
building permit where requirements for access are met.)
HAVE DRIVE ACCESS
PERFORMANCE STANDARDS BEEN GIVEN TO APPLICANT? ________________
Date:
___________________________
_________________________________________________
Signature of Zoning
Officer