DCPZP-2015-00344 - Laserfiche WebLink

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Dane County Highway and Transportation Department ACCESS PERMIT This application and 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 County Code of Ordinances. Applicant is to complete all of the following requested information(please print or tvne): County Trunk Highway to 7t t{ 4hlC LA170Pt�L1Lo$ (.W11apSoR Coni.ktAc4.S' which access is requested: (...NJ Name \ ?9 kl. aNG1 901N-c g--a kt Address Nxo1:231..".101 iJ1 5 eDG2 City State Zip 831 G50 831 2 G c2 Home Phone Work Phone FAX Existing Access?: If yes,how modified?(check one): Yes 0 No fl Relocated 0 Removed , Change of use 0_Culverlreplase. 0 AsplraltPaving Describe Use A-l(1!G—ll t)S't^ RielAl[ Of Flan-. RP:StVat,ntAl: MtiVitS b,t-ktt.--{ 1. Location(check one): 121Town ❑Villa a 0 or IN 1f,I DS p Q. Section Name of Highway and Norta/South/East7West side: 11Gvtl s .,—T. ,1.. i : ._ Nance of nearest cross road: 14xp_ A 1- Gy-1Lc- A> Distance and direction from nearest cross road: Ace ROSS. Ft,ort .Mkp, ' . Si'tiaQt■acs zoo 1 —„46Pr DI ,-to Existing Zoning: C,,j. Zoning meets intended use?: Ui Yes 0 No Type;o'fPermit Requested(refer to reverse side for explanation of controlled and non-controlled aecess) 0 S50 Temporary Controlled Access 0 S35 Temporary Non-Controlled Access- ❑£50 Agricultural Controlled Access ❑S35 Agricultural Non-Controlled Access lei [0 150 Residential(single family)Controlled Access 0 S35 Residential(single family)Non-Controlled Access hC g100 Residential(multi-family)Access k ifI tt [3 5100 Commercial,<100 ADT1' yt� S500 Private/Public,New/Existing,Street or Road 0 5250 Commercial,>100 and<1,000ADT �+V t. S20 Miscellaneous [3 5500 Commercial,>1,000 ADT ADTdenotee Average Daily Traffic. Data substantiating ADT for access or road intersections may betetpiired. i Check or money order in the amount of 1.7( ,payable to Date.County Highway and Transportation Departrnentis enclosed. Cash will only b accepted in person. Do not send cash in the maiL The-applicant understands and agrees that the permitted work shall comply with all permit provisions and conditions listed on the tonne side hereof any special provisions listed below or attached hereto,and any and all plans,detail's or notes attached hereto and made a part thereof. Property owner is responsible for notifying Dane County of any conditions and/or restrictions. By . A .V-1\--"...----, Date 81 fci AA Signature ofApplicant/Representative NOTE: Application should be accompanied with plans or plat or CSM when appropriate. Application fee must accompany alt applications.Applications to be submitted to Dane County Highway and Transportation Department,2302 Fish Hatchery Road,Madison,WI 53713. Contact the Assistant Commissioner at 266-4036 or Engineering,office at 266-4037 with any questions. Any applicants which are denied a permit may appeal the decision to the Dane County Transportation Committee, DO NOT WRITE OR TYPE BELOW THIS LINE—FOR DANE COUNTY USE ONLY PERMIT APPROVAL BY DANE COUNTY COUNTY PERMIT NUMBER: C—/5-- The foregoing application is hereby approved and permit issued by Dane County subject to full compliance by the Applicant with all provisions and conditions stated herein and on the reverseside-hereof and all attachments hereto. Ott►erSpeolal Provisions f 14110-'1"-ex; 1 ;�Crrss Q�rnctiel,rr�viiecr ,sriV+.4 tt�'cess{� .r.-.se, o _ ! , By _"-(4 /12/A -S_ Signore . Dane County Representative' Dale a.By (elms if115riont - r,Vdsa-,<p-- `1 Title Phone vw-roue Page I oft