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A Dane County Department of Public Works, Highway and Transportation <br /> ACCESS PERMIT CD <br /> r62 <br /> This permit is required and shall be issued in accordance with the provisions of Section 83.027 of the Wisconsin Statutes and Chapter 79 of the Dane <br /> County Code of Ordinances. <br /> Name Co.Trunk Hwy in which access is requested: <br /> Tom& Rena Thompson TT <br /> Street Address Town,Village,City Section <br /> 119 Vine St Town of Medina 4 <br /> City State Zip <br /> Sun Prairie WI 53590 <br /> Home Phone Work Phone Fax Number E-Mail Address <br /> (608)088-3737 (608)082-7983 tomandrena@yahoo.com <br /> Existing Access? If yes,how modified? <br /> No ❑ Relocated ❑ Removed ❑ Change of Use ❑ Culvert Replace ❑ Asphalt Paving <br /> Describe Use: <br /> Single family residential driveway <br /> North/South/EastNVest Side Nearest Cross Road Distance&Direction of nearest cross rd Existing Zoning: Meets Intended Use? <br /> East Clarkson Road 1,400 feet North RH 1 © Yes ❑ No <br /> Type of Permit Requested: <br /> ❑ $110 Temporary Controlled Access ❑ $75 Temporary Non-Controlled Access <br /> ❑ $110 Agricultural Controlled Access ❑ $75 Agricultural Non-Controlled Access <br /> ❑ $110 Residential (single family)Controlled Access © $75 Residential(single family)Non-Controlled Access <br /> ❑ $220 Residential,Joint Access>1 parcel ❑ $220 Commercial,<100 ADT`* <br /> ❑ $1,100 Private/Public, New/Existing,Street or Road ❑ $550 Commercial,>1000 and<1,000 ADT <br /> ❑ $45 Miscellaneous ❑ $1,100 Commercial,>1,000 ADT <br /> "ADT denotes Average Daily Traffic. Data substantiating ADT for access or road intersections may be required. <br /> Fees paid in full on 10/16/2014 <br /> PERMIT APPROVAL BY DANE COUNTY COUNTY PERMIT NO. 14A029 <br /> The application submitted is hereby approved and this permit is issued by Dane County subject to full compliance by the Applicant with all provisions <br /> and conditions stated herein and on the reverse side hereof and all attachments hereto. <br /> Other Special Provisions: <br /> This permit is contingent on all other Local,State and/or County Agency permits,zoning and approvals and applicant must <br /> comply with all federal,state and local laws,ordinances and regulations. <br /> The driveway shall be constructed to drain away from the edge of road for a minimum of 8'and will require an 18"diameter <br /> culvert 30 feet long with approved metal apron ends. Traffic control shall be as per the MUTCD. <br /> Check#8516 <br /> By 10/24/2014 <br /> u of Dane County Re sentative Date <br /> reggar Petersen Highway Engineer 608-266-9081 <br /> Name and Title Phone <br /> Page 1 of 2 <br />