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2. APPLICATION FOR NEW OR REPLACEMENT RESIDENTIAL DRIVEWAY

4. Instructions to Applicant:

   1. The applicant must be the Property Owner – No Contractors or Consultants.

   2. Contact the Permit Supervisor, Brad Miller at 330-799-1581 x8134 or at 330-301-9201,  to arrange for an on-site meeting and for him to complete the bottom portion of the permit form.

   3. Once completed by both parties, the permit supervisor will collect the fee and a permit will be granted upon the approval of the Mahoning County Board of Commissioners.

   4. Application fee of $25.00 is due at the time of the on-site meeting, payable by cash or check. Make check payable to the Mahoning County Treasurer.

   Return all items to:

   The permit supervisor or mail to:

   Mahoning County Engineer
   940 Bears Den Road
   Youngstown, Oh 44511
   Phone: 330-799-1581
   Fax: 330-799-4600
   E-Mail: [email protected]

   
   

6. Name
7. Email Address
9. Address
11. City
12. State
13. Zip Code
15. Phone Number
16. Fax Number

18. Application

    (requesting permission to enclose the side of the road ditch within the limits of a county or township highway, Section 5547.04 R.C.)

    To the Board of County Commissioners of Mahoning County, Ohio

20. The undersigned applicant requests permission to enclose the side road ditch at / on
22. County Highway Number (C.H. no. _______)

    township by installing drainage pipe and a fill over same in the roadside ditch for driveway purposes.

24. In (Township)
    -- Select One --Austintown TownshipBeaver TownshipBerlin TownshipBoardman TownshipCanfield TownshipCoitsville TownshipEllsworth TownshipGoshen TownshipGreen TownshipJackson TownshipMilton TownshipPoland TownshipSmith TownshipSpringfield Township
26. The proposed enclosure is for a
    -- Select One --NewReplacement

    Driveway culvert

28. The said enclosure is to be placed
    -- Select One --NorthEastWestSouth

    side of said highway

29. at a place approximately
31. -- Select One --NorthEastWestSouth

32. of

35. Agreed that the drainage pipe and the fill over same will be placed under the supervision of the county engineer and in accordance with his recommendations as to size, type, grade, etc., and it is further understood and agreed that applicant will pay a fee in the amount of $25.00 and will pay the actual cost of the materials necessary for such installation at the time said permit is issued.

37. DATE: __________________ 20___ 

38. ___________________________________

    APPLICANT SIGNATURE

42. Recommendation of the County Engineer

    I have viewed the site of the above proposed installation and hereby approve the granting of a permit for said construction.

    The materials for the construction of the same are as follows:

    ____ FEET OF _______ INCH _____________________ PIPE 
    _______CU. YDS. CONCRETE ________ CU. YDS. OF EARTH FILL ________ CU. YDS. OF STONE OR SLAG SURFACE.

44. Mahoning County Engineer

    By: _________________________________

    District or Permit Supervisor

Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

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