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Dane County Department of Public Works, Highway and Transportation <br /> ' ACCESS PERMIT <br /> #UL <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 /> Quality West Construction T <br /> Street Address Town,Village,City Section <br /> PO Box 12 Town of Sun Prairie 22 <br /> City State Zip <br /> Mt Horeb WI 53572 <br /> Home Phone Work Phone Fax Number E-Mail Address <br /> (608)219-9163 (608)219-9163 (608)798-3461 qualitywestinc @gmail.com <br /> Existing Access? If yes,how modified? <br /> Yes ❑ Relocated ❑ Removed © Change of Use ❑ Culvert Replace ❑ Asphalt Paving <br /> Describe Use: <br /> Joint Access for 2-Residential Lots <br /> North/South/East/West Side Nearest Cross Road Distance&Direction of nearest cross rd Existing Zoning: Meets Intended Use? <br /> North County Road VV 0.36 Miles east A-2 n Yes ❑ No <br /> Type of Permit Requested: <br /> ❑ $110 Temporary Controlled Access El $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 El $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 4/2/2015 <br /> PERMIT APPROVAL BY DANE COUNTY COUNTY PERMIT NO. 15A005 <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. No concrete pavement allowed in the right of way. <br /> The access must be graded to drain away from the edge of road for a minimim of 8'and will require an 18"diameter culvert <br /> pipe 30 feet long with approved metal apron endwalls. The existing culvert may be re-used at the owners discretion. <br /> Check#17016 <br /> By JAI 4/6/2015 <br /> at re of D- County Refesentative Date <br /> reggar Petersen ighway Engineer 608-266-9081 <br /> Name and Title Phone <br /> Page 1 of 2 <br />