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Dane County Highway and Transportation Department <br /> ACCESS PERMIT <br /> This application and permit is required and shall:be issued in accordance with.the provisions of Section 83:027 of the <br /> Wisconsin Statutes and Chapter 79 of the Dane.County Code of Ordinances. <br /> Applicant is to complete all of the following requested information(please'print or type): <br /> County Trunk Highway to Si d.{. <br /> 'i\1,t iN L A )O Pr,v Lo S (W1NDSo R t'aptiltat.ss •which access is requested: G V <br /> Name <br /> Vr125 N, 1.4\G, 90\NZ F-.n tip <br /> Address <br /> N NC.Dt.>'E'ltat1 'v\.)\ $6062 <br /> City State Zip <br /> 8'31 G5O e)- 1 'lo <br /> Home Phone Work Phone FAX <br /> Existing Access?: If yes,how modified?(check one): <br /> %Yes O No 0 Relocated 0 Removed Change of use 0 Culvert replace 0 Asphalt Paving <br /> Describe Use' l-li'&tt l9 S' Rtel ActL•IOf 1C>" RvStb'Gh+'ZiAI— tDI:I1S ,t kL'-t <br /> Location(check one): E Town 0 Village 'Q City: of w 11,,1 tz,S1a F;- Section <br /> Name of Highway and North/South/East/West side:: \ V tt •EAS-r : i>' <br /> Name of nearest cross road: N A-PL'F Ls c Gs,t Lc et.,A l> <br /> Distance and direction from nearest cross road: Ac,go se, FR,pi ti HA?i.$ S4?ito, ic, zit)0I 6,4,,Vt.DIQ (,jto <br /> Existing Zoning:. G 1 Zoning meets intended use?: t5E1 Yes fl No <br /> Type of Permit Requested(refer to reverse side for explanation of controlled and non-controlled access): <br /> 0 S50 Temporary Controlled Access 0$35 Temporary Non-Controlled Access <br /> 0$50 Agricultural Controlled.Access 0$33 Agricultural Non-Controlled Access <br /> 0 S50 Residential(single family)Controlled Access ❑S35 Residential(single family)Non-Controlled Access <br /> i XS100 Residential(multi-family)Access ilkrtS..-ts Ole 0$100 Commercial,<100 ADT**' <br /> rts? <br /> •5500 Private/Public New/Existing,Street or Road ED$250 Commercial,>100 and<1,000 ADT <br /> i.$20 Miscellaneous 0 S500 Commercial,>1,000 ADT <br /> ADTdenotes Average Daily Traffic. Data substantiating ADT for access or road intersections may be required. <br /> Check or money order in the amount of no ,payable to the Dane County Highway and Transportation <br /> Department is enclosed. Cash will only baccepted in person. Do not send cash in the mail <br /> The applicant understands and agrees that the permitted work shall comply with all permit provisions and conditions listed on <br /> the reverse side hereof;any special provisions listed below or attached hereto,and any and all plans,details or notes attached <br /> hereto and made a part thereof. Property:Amer is responsible for notifying Dane County of any conditions and/or restrictions. <br /> H31 a d Date 81 al(kat...tgkl re ofAp icant/Representative <br /> NOTE: Application should be accompanied with plans or plat or CSM when appropriate. Application fee must accompany <br /> an applications. pplications to be submitted to Dane County Highway and Transportation Department,2302 Fish Hatchery <br /> Road,Madison;WI 53713. Contact the Assistant Commissioner at 266-4036 or Engineering.office at 266-4037 with any <br /> questions. Any applicants which are denied a permit may appeal the decision to the Dane County Transportation Committee; <br /> . DO NOT WRITE OR TYPE BELOW THIS LINE—FOR DANE COUNTY USE ONLY <br /> PERMIT APPROVAL BY DANE COUNTY COUNTY PERMIT NUMBER: ,IS� <br /> The foregoing application is hereby approved and permit issued by Dane County subject to full compliance by the Applicant <br /> With all provisions and conditions stated herein and on the reverseside hereof and all attachments hereto. <br /> rcL <br /> OtierSpecialProvisio Oar s "90,19 cucI Lreivr�eof <br /> ex1 acz s#'C. ' <br /> • <br /> By . , �. s <br /> Signatu Dane-County Representative Pate • <br /> By (;IU(Misscorr..r - - Ufa-403' <br /> Title Phone <br /> uwa;})O Am Page I of 2 1 4F.,a ft..0p.rmt...,+n.s.1c <br /> h <br />