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Dane County Department of Public Works, Highway and Transportation <br /> x; 47.1►:; <br /> ACCESS PERMIT <br /> �F1 ;vly, <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 /> Adam Gunderman Y <br /> Street Address Town,Village,City Section <br /> 1900 Prairie St Town of Roxbury 18 <br /> City <br /> State Zip <br /> Prairie du Sac WI 53578 <br /> Home Phone Work Phone Fax Number E-Mail Address <br /> (608)643-4667 adam @ganserconstructioninc.com <br /> Existing Access? If yes,how modified? <br /> No ❑ Relocated ❑ Removed ❑ Change of Use ❑ Culvert Replace ❑ Asphalt Paving <br /> Describe Use: <br /> Residential Driveway <br /> North/South/East/West Side Nearest Cross Road Distance&Direction of nearest cross rd Existing Zoning: Meets Intended Use? <br /> North Bergman Road _1,150 feet west _ R-1 G Yes ❑ No <br /> Type of Permit Requested: <br /> ❑ $110 Temporary Controlled Access ❑ $75 Temporary Non-Controlled Access <br /> [1 $110 Agricultural Controlled Access ❑ $75 Agricultural Non-Controlled Access <br /> LI $110 Residential(single family)Controlled Access ki $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 4/6/2015 <br /> PERMIT APPROVAL BY DANE COUNTY COUNTY PERMIT NO. 15A006 <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 Seeclal 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 access must be graded to drain away from the edge of road for a minimim of 8'and will require a 12"diameter culvert <br /> pipe between 24 to 30 feet long with approved metal apron endwalls. The driveway access point may be paved with asphalt <br /> under this permit but no concrete pavement Is allowed In County Highway right of way. <br /> Check#14280 <br /> By � ; z 4/20/2015 <br /> Signature of Daneg`ounty Representative Date <br /> Greggar Petersen Highway Engineer 608-266-9081 <br /> Name and Title Phone <br /> Page 1 of 2 <br />