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Dane County Department of Public Works, Highway and Transportation <br /> h' <br /> ..r <br /> ty ACCESS PERMIT <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 /> Brian Henning TT <br /> Street Address Town,Village,City Section <br /> 2803&th Avenue Town of York 33 <br /> City State Zip <br /> Chetek WI 54728 <br /> Home Phone Work Prone Fax Number E-Mail Address <br /> (715)570-4464 (715) 570-4464 bhenning@newaubum.k12.wi.us <br /> Existing Access? If yes,how modified? <br /> No ❑ Relocated ❑ Removt d ❑ Change of Use ❑ Culvert Replace ❑ Asphalt Paving <br /> Describe Use: <br /> New asphalt paved access to lot being created for residential home. <br /> North/South/EastMtest Side Nearest Cross Road Distance&Direction of nearest cross rd Existing Zoning: Meets Intended Use? <br /> West Deansville Road 1/2 mile south RH 1 © 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 Ei $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 /> r ❑ $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 12/1/2014 <br /> PERMIT APPROVAL BY DANE COUNTY COUNTY PERMIT NO. 14A036 <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. A#18(18"diameter or 21"x15"arched)culvert 30 <br /> feet long is required with 2 approved metal endwalls. Traffic control shall be as per the MUTCD. <br /> Check Number 40 3 <br /> j I ,:. i` <br /> y' �,- 12/1/2014 <br /> By �` `. :'f; \ <br /> Signature of Dace CounE;r Representative L'' Date <br /> %Greggar Petersen Highway Engineer 608-266-9081 <br /> Name and Title Phone <br /> Cr <br /> Page 1 of 2 <br />