B. Alan Brubaker, P.E., P.S., Summit County Engineer For Cities & Townships:

Permissive License Fee Allocation Form

Fields marked with an * asterisk are required.

Submitted by

Submitted by (City/Village) *

Phone Number *

First Name *

Last Name *

Address *

City *

State *

Zip Code *

Improvements

Road(s) or Street(s) to be Improved *

Limits of Improvements: Beginning *

Limits of Improvements: Ending *

Description *

Existing Pavement Type (Include Base) *

Existing Pavement Width *

Roadway (Right-of-Way width) *

Costs

Pavement

Grading & Drainage

Structures (over 10 ft.)

Right-of-Way

Plan Preparation

Other

Total

Funds Requested

Remarks

Digital Signature *

I have read the Permissive License Tax Allocation Procedures which can be found here.

Accessing our website tells us you agree to our use of cookies. However, you can change your cookie settings at any time.
Privacy Policy