DRIVEWAY PERMIT APPLICATION
VILLAGE OF CLEMMONS DEPARTMENT OF PUBLIC WORKS

LOCATION OF PROPERTY

STREET ADDRESS:  ______________________________________________  LOT #: ___________

PROPERTY OWNER / REPRESENTATIVE

NAME:                         _______________________________________________

ADDRESS:                 _______________________________________________

                                      _______________________________________________

                                      _______________________________________________

PHONE NUMBER:    (______)________________________________________ 

AGREEMENT
I, the above signed property owner or representative, request permission to construct driveway(s) on public right-of-way at the above location.  I agree to construct and maintain the driveway(s) in absolute conformance with the current “Village of Clemmons Driveway Ordinance” as adopted by the Village of Clemmons Council and incorporated by reference this Agreement.  I agree to construct and maintain driveway(s) in a safe manner so as not to interfere with or endanger public travel.
I agree that no signs or objects will be placed on or over the public right-of-way.
I agree that the driveway(s) will be constructed as shown on the sketch on the attached plans which are incorporated by reference into this agreement.
I agree that driveway(s) as shown on this agreement includes any approach tapers, storage lanes, speed change lanes, or median openings as are deemed necessary.
I agree that if any future improvements to the roadway become necessary, the portion of the driveway located on public right-of-way will be considered the property of the Village of Clemmons and I will not be entitled to reimbursement or have any claim for present or future expenditures for additional driveway construction that might be necessary.
I agree that this permit becomes null and void if construction of the driveway(s) is not completed within 90 days after the approval date below.
I agree to indemnify, save and hold harmless the Village, their agents, servants, and employees from and against all claims, damages, loss, expense or liability arising from or in any way growing out of the granting of this permit.
 
 
(FOR COMMERCIAL PROPERTIES):
Distance from the intersection of  ______________________Street:   ____________ft.
 
Property will be used for:  _________________________________________________________
 
Property Zoning:_____________________ Type of Construction: _________________________
 
Provide sketch showing proposed building, existing building, driveways, pavement width, right-of-way width, street features, storm drainage details, and other related information.

DRIVEWAY WIDTH FOR COMMERCIAL PROPERTIES:

  1. Width ________________ ft.,  located on _______________________ Street, street pavement

    Width ________________ ft., right-of-way width __________________ ft.
  2. Width ________________ ft.,  located on _______________________ Street, street pavement

    Width ________________ ft., right-of-way width __________________ ft.
  3. Width ________________ ft.,  located on _______________________ Street, street pavement

    Width ________________ ft., right-of-way width __________________ ft.