Application Fee: $50.00/per sign

                                                                                                                  Paid _______________

Town of Bridgton

Three Chase Street, Suite 1, Bridgton, Maine 04009]

207-647-8786

Proposed Street(s) Name Request

As per The Street Naming and Addressing Ordinance adopted on June 12, 1996 at the Annual Town Meeting “Section 7.b. New Subdivisions.  Any prospective subdivider shall show a proposed road name(s) in accordance with the provisions of this Ordinance.  Final approval shall be granted by the Board of Selectmen following consultation and pre-approval by the E-911 Addressing Officer.  Approved road name shall be shown on the mylar prior to final approval and signature by the Bridgton Planning Board.

Date:__________________________________

Applicant Name: ____________________________________

Applicant Address: ______________________________________________________

Applicant Phone Number: _________________________________________________

Map  __________       Lot __________

Subdivision Name (If Applicable) :__________________________________________

Proposed Street Name(s) __________________________________________________

                                          __________________________________________________

                                          __________________________________________________

 _____________________________________             _______________________________

Applicant/Owner Signature                                            Date                                       

_____________________________________               ________________________________

 Reviewed by                                                                    Date 

_____________________________________               _________________________________

Approved By:

Town Manager for Board of Selectmen                  Date           

NOTE:  Fees for necessary street sign(s) is determined in the Town of Bridgton Fee Schedule and is due and payable by the applicant.  Purchase and installation of the street sign(s) will be the responsibility of the Town of Bridgton Public Works Department.