ࡱ> $& !"#s bjbj>>dpTpTttTT8 -(h " ,,,,,,,$.t1r7, $ "F " 7,4,%%% ,% ,%%ry)T)&!)+,0 -)1&!1)1) % 7,7,$ - 1 T t: Aanvraag verlagen boordstenen en/of maken van een oprit330 03-20101006   Gemeentebestuur Merelbeke Dienst stedenbouw Hundelgemsesteenweg 353, 9820 MERELBEKE Tel. 09 210 33 40 Fax 09 210 32 99 E-mail:  HYPERLINK "mailto:ros@merelbeke.gov.be" ros@merelbeke.gov.be In te vullen door de dienst raad en college ontvangstdatumWaarvoor dient dit formulier? Met dit formulier vraagt u de aanleg aan van een oprit op het openbaar domein en/of een verlaging van de boordstenen. Aan te leggen opritten en/of verlagen van boordstenen op openbaar domein moeten steeds aangevraagd worden. De standaardbreedte van de oprit is 4 meter met een maximumbreedte tot 6 meter. Type verharding : betonklinker 2211 8 cm, geplaatst op fundering van mager beton 15 cm dik, kleur te bepalen door dienst werken. Het is toegelaten om twee van elkaar gescheiden opritten aan te leggen met een gezamenlijke breedte van maximum 6 meter. De verharding op openbaar domein kan maximum de helft van de totale perceelsbreedte bedragen. Parkeerplaatsen op privaat domein zijn enkel bereikbaar via deze oprit. Wil u dit formulier liever digitaal invullen? U kan dit formulier ook per e-mail ontvangen. Stuur daarvoor een e-mail naar  HYPERLINK "mailto:ros@merelbeke.gov.be" ros@merelbeke.gov.be  Gegevens aanvrager1Vul hieronder uw persoonlijke gegevens invoor- en achternaam FORMTEXT      straat en nummer FORMTEXT      postnummer en gemeente FORMTEXT      telefoonnummer FORMTEXT      gsm-nummer  FORMTEXT      e-mailadres FORMTEXT      2Vul hieronder facturatiegegevens in (indien verschillend van de persoonlijke gegevens)voor- en achternaam FORMTEXT      firmanaam FORMTEXT      straat en nummer FORMTEXT      postnummer en gemeente FORMTEXT      ondernemingsnummer  FORMTEXT  FORMTEXT  FORMTEXT  FORMTEXT . FORMTEXT  FORMTEXT  FORMTEXT . FORMTEXT  FORMTEXT  FORMTEXT Gegevens perceel3Vul hieronder bijkomende gegevens in aangaande het perceelStraat en nummer FORMTEXT      Indien geen huisnummer Tussen nr.  FORMTEXT       en nr.  FORMTEXT      Kadastrale gegevensAfdeling :  FORMTEXT       Sectie :  FORMTEXT       Nummer :  FORMTEXT      Goedgekeurde verkaveling FORMCHECKBOX  Ja, vermeld lotnummer :  FORMTEXT       FORMCHECKBOX  Neen Huidige toestand FORMCHECKBOX tegels FORMCHECKBOX gras  FORMCHECKBOX klinkers FORMCHECKBOX aarde  FORMCHECKBOX grind FORMCHECKBOX andereGegevens aan te leggen opritten en/of te verlagen boordstenen4Vul aan:Aantal te verlagen boordstenenAantal aan te leggen opritten FORMCHECKBOX 1 FORMCHECKBOX 2Oppervlakte van de aan te leggen oprit op openbaar domein Gewenste breedte van de oprit op openbaar domein Bijlagen FORMCHECKBOX Inplantingplan voor aangevraagde lozingspunten FORMCHECKBOX Fotoreportage van het openbaar domein voor het volledige perceelTarieven5Voor de aanleg van opritten en het verlagen van boordstenen gelden onderstaande tarieven :Prijs voor verlagen boordstenen  7,00 EUR/begonnen meterPrijs voor oprit in grijze betonklinker 50,00 EUR/mToepasselijk retributiereglement: Retributie op het leveren van technische prestaties ten behoeve van derden door het departement grondgebiedzaken, cluster werken (besluit gemeenteraad van 27/04/2010)Ondertekening7Ik verklaar hierbij dat de gegevens in dit formulier naar waarheid werden ingevuld. 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