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ONTARIO ROAD <br />DRIVEWAY REPLACEMENT FORM <br /> <br /> <br />Property Owner Name : <br /> <br />Property Address : <br /> <br />Phone Number : <br /> <br /> <br />Modify Driveway Access: YES NO <br /> <br /> <br />If you answered “No” to the questions above, the following information is not needed. <br /> <br />If you answered “Yes” to the above question, please complete the following: <br /> <br />Type of Driveway: BITUMINOUS CONCRETE <br /> <br />Driveway Width*: <br /> <br />Driveway Length to be replaced: <br /> <br /> <br /> <br />By signing this form, I hereby agree that my assessment will increase by 50% of <br />the cost of curbing replacement at my driveway based upon a lineal foot charge of <br />$17.80 multiplied by the width of my driveway curbing as determined by the City’s <br />Engineer*. I am also acknowledging that I will be responsible for all costs <br />associated with driveway replacement needed to blend the slope of my existing <br />driveway to the new driveway curbing as outlined in the City Memo dated June 24, <br />2010. I understand that payment for the driveway replacement work will need to <br />be made by me directly to the contractor performing said work. <br /> <br /> <br /> <br />Signature: Date: <br /> <br /> <br />* Based on the driveway width, a City representative will determine the amount of curb to <br />be removed and replaced. <br /> <br /> <br /> <br />If you have questions regarding completion of this form please call Lee Elfering, City <br />Engineer, at (763) 780-0450 ext. 3, or Lyle Splittstoser, Inspector, at (651) 587-9209. <br />33