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FROM PHONE NO. : Oct. 27 2009 03:43PM P3 <br /> • Dane County Department of Public Works, Highway and Transportation <br /> 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 /> Tom Henderson <br /> Street Address Town,Village,City Section <br /> 417 Forest St Town of Springdale 11 <br /> City State Zip <br /> Mt.Horeb Wi 53572 <br /> Home Phone Work Phone Fax Number E-Mail Address <br /> (608)437-5214 (608)333-5391 <br /> Existing Access? If yes,how modified? <br /> Yes EJ Relocated 0 Removed Change of Use [❑ Culvert Replace ❑ Asphalt Paving <br /> _ <br /> Describe Use; . <br /> Existing farm access,fire*2712 to Joint use access <br /> North/South/EastNVest Side Nearest Cross Road Distance&Direction of nearest cross rd Existing Zoning: Meets Intended Use? <br /> CTH J,east side , CTH PD 2000 feet south A-1 wj Yes ji No <br /> Type of Permit Requested: <br /> ❑ $110 Temporary Controlled Access L7 $75 Temporary Non-Controlled Access <br /> ❑ $110 Agricultural Controlled Access E $75 Agricultural Non-Controlled Access <br /> ❑ $110 Residential(single family)Controlled Access ❑ $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 11/1/2009 <br /> PERMIT APPROVAL BY DANE COUNTY COUNTY PERMIT NO. 09A017 <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 Provision <br /> This access permit Is contingent on Town Board Approval and other required Permits and Approvals. <br /> This access permit is contingent on proper zoning of this property. <br /> Field access located 2500 feet south of CTH PD to be removed as part of this permit. <br /> gy .® (, 10/7/2009 <br /> giat`ure of Da -County Representative Date <br /> G •ggar Petersen Highway Engineer 608-266-9081 <br /> Name and Title Phone <br /> Page 1 of 2 <br />