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Dane County Department o'Public Works, Highway and Transportation AC ESS PERMIT This application and permit is required and shall .e issued in accordance with the provisions of Section 83.027 of the Wisconsin Statutes and Chapter 79 of the Dane Coun Code of Ordinances. • Applicant is to complete all of the following reques.•d information(please print or type): County Trunk Highway to , cie D. 20 A9Al which access is requested: pg Name I iNS aP2.0S3 WW P Address /,eity �A State- .c35,3 Zip og S41S"- f' -f 3 d8 ' 7/-1738 loa 8).2?? " 900 ome hone WorlCPh ne FAX Existing Access?: If yes,how modified?(chec one): 3gYes No Relocated ❑Remov.d Change of use _ Culvert replace ❑ Asphalt Paving Describe Use: 6/44 N, , -/�elti. ,: - _ Ge!■ Location(check one): Il Town ❑Village I City of . n/ 4, Section i?_Cto Name of Highway and North/Sout, +'" est side: /76 Name of nearest cross road: I/ 4 ,q /l2 Distance and direction from nearest cross W road: `fp,2 (. ka tie- -AZe- 5o4,,-(4 Existing Zoning: 1St e.A/-74A( Zoning meets intended use?: Yes No Type of Permit Requested(refer to reverse side for -xplanation of controlled and non-controlled access): $110 Temporary Controlled Access ❑ $75 Temporary Non-Controlled Access ❑ $110 Agricultural Controlled Access n $75 Agricultural Non-Controlled Access ❑ $110 Residential(single family)Controlled Acces — $75 Residential(single family)Non-Controlled Access ji?4/$220 Residential,Joint Access> 1 parcel ❑ $220 Commercial,<100 ADT** Iii 1,iUU Private/Public,New/Existing,Street or Ro . ❑ $55(i Commercial,>100 and<1,000 ADT $45 Miscellaneous r- (__, $1,100 Commercial,>1,000 ADT **ADT denotes Average Daily Traffic. Data substanti.ting ADT for access or road intersections may be required. OJ Check or money order in the amount of r pay ble to the Dane County Department of Public Works,Highway and Transportation is enclosed. Cash will only be a cepted in person. Do not send cash in the mail. The applicant understands and agrees that the permitt-. work shall comply with all permit provisions and conditions listed on the reverse side hereof, any special provisions listed b-low or attached hereto, and any and all plans, details or notes attached hereto and made a part the/ Property owner is resp•nsible for notifying Dane County of any conditions and/or restrictions. By Magri rt.L.". Date r/(1497 i: .to 'Ap. icant/Representative • E: Application should be accompanied with plan. or plat or CSM when appropriate. Application fee must accompany all applications. Applications to be submitted to Dale County Department of Public Works, Highway and Transportation, 2302 Fish Hatchery Road, Madison, WI 53713. Cot tact the Assistant Commissioner at 266-4036 or Engineering office at 266-4037 with any questions. Any applicants which e denied a permit may appeal the decision to the Dane County Public Works and Transportation Committee, DO NOT WRITE OR TYPE BELO THIS LINE--FOR DANE COUNTY USE ONLY PE! MNfIT APPROVAL• BY DANE COUNT COUNTY PERMIT NTJ MBER:07C-, e The foregoing application is hereby approved and pe it issued b • Dane Coun sub'ect . t .mpliance by the Applicant with all provisions and conditions stated herein and on e r: erse e a>�f#id(4 : : .'tents I eto. Other Special Provisions: 3 c V e 11 1_ f i AUG 0 2 2007 j Additional culverts may have to be located o' highway right-of-way to best fit drainage needs. The diameter of the culvert must be adequately sized. I HItiHWFc a - i By S-/6 -07 Signature of Dane County Representative Date By • -..e - 266 --1‘0/1 Title Phone I/2/2007,2:49 PM Page 1 of 2