Street Light Application Form   GREENSVILLE COUNTY STREET LIGHT PLACEMENT APPLICATION Name of Applicant:________________________________ Date: _______________ Address of Applicant:________________________________________________________                ________________________________________________________ Telephone #:  _____________________________________________________ Category Applying Under: (1) Road Conditions _____ (Fee of $15.00 per light) (2) Pedestrian Access _____ (Fee of $15.00 per light) (3) Project Area _____ (Fee waived) Location of light(s) requested: ____________________________________________________ Tax Map/Parcel Number: ________________________________________________________ Power Company servicing the area: _____________________________________________ Please state reason(s) for request: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ YOU MAY ATTACH DRAWINGS, PICTURES, OR OTHER MATERIAL SUCH AS ACCIDENT REPORTS, CRIMINAL INCIDENT REPORTS, OR GRANT INFORMATION YOU BELIEVE WILL ASSIST IN THE REVIEW OF THIS REQUEST. ______________________________________________________________________________ SIGNATURE DATE ********************************************************************************* ______________________________________________________________________________ RECEIVED BY DATE Transportation Safety Commission meeting:_______________ Action:_____________________ Board of Supervisors meeting:_______________ Action:_____________________