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2. Date:*
   Date:

3. Permit Number____________________________________________

5. The undersigned having read Chapter 905 of the Codified Ordinances of the City of Lancaster and the Instructions to Applicants hereby makes application for Curb Cut or Driveway Permit in compliance with said Ordinances and submits application in DUPLICATE with the necessary data pursuant hereto.

   ________________________________________________________________________________________________________

7. INSTRUCTIONS TO APPLICANTS
   1. Application must be filed with the City Building or Engineer’s Office no less than five days prior to the date that the applicant proposes to commence work.
   2. A PLOT PLAN, submitted in, drawn in such a manner as to indicate the extent of the proposed construction, curb removal, or

      elimination, as the case may be, must accompany each application.

   3. No work will be permitted on the project until the application is approved, permit issued and returned to the applicant.

9. Site Address1*
11. Lot #:
12. Parcel #:
14. Located between:(street names)
16. Zoning District:
17. Flood Plain Zone:
    -- Select One --YESNO
18. Development permit #:
20. Purpose of Curb Cut or Driveway:*
22. Estimated Start Date:
23. Estimated Finish Date:
24. Estimated Cost: $*
26. Owners Name:*
28. Owners Address:
29. Owners Address2:
31. City
32. State
33. Zip
35. Owners Phone No:
36. Owners Email:
38. Contractor Name*

    Note: All contractors must be registered with the city.  If more that one contractor please provide a list of contractors including name, address, phone number and work providing.

39. Registration No:
41. Contractor Address:
42. Contractor Address2:
44. City
45. State
46. Zip
48. Phone No:*
49. Contractor Email:*
51. Functional Classification of the street to which the driveway will connect:*

53. Draw a sketch of proposed work, including dimensions, locating the work and extent of work on a separate sheet of paper or site plan . 

    The work shall be performed in conformity with the pertinent City of Lancaster Standard Construction Drawing

57. Note 1: If work will differ from a City of Lancaster Standard Construction Drawing, then submittal of a detailed drawing of the drive including all dimensions and grades will be required with this application.

    Note 2: A completed “Permit For The Use Of Public Right - Of - Way” is required if the work requires the closing of any part of the street or public right-of-way.

59. I hereby certify that the foregoing statements and attachments are true:*

    Applicant Signature

60. Attach Site Plan:

    Or email plans to buildingsubmittal@ci.lancaster.oh.us  or building@ci.lancaster.oh.us

62. Applicant Address:*
63. Applicant Address2:
65. City
66. State
67. Zip
69. Applicant Phone No.*
70. Applicant Email:*
74. *OFFICE USE ONLY

76. Date Approved:_____________________________

77.  Approved By:_______________________________________

Leave This Blank:


78. 1. Receive an email copy of this form.
79. Email address

    This field is not part of the form submission.

80. Submit

* indicates a required field