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TOWN OF PRIMROSE APPLICATION FOR DRIVEWAY PERMIT APPLICANT INFORMATION: DATE: 2 Name of Applicant : N4 IA/ Di-/e rixe,A e��DE/Z Stic Address of Applicant: 77-KJG�- Goo �a Signature of Applicant : X Complete Owner Information if different than Applicant Name of property owner : w-re-e-z-'9rn -0 HE Address of property owner: L o T / S— 63 6 i / 2-2_ N19 aTZL .7irlr71 12�,/IL 7�wiv✓N=/� s7) 9b.1.1ety, w.l. Signature of property owner: X A L 1740 ?cif Applicant Agrees with the following Requirements of the Town of Primrose with his/her signature on the above applicant information. 1 . Application fee for Driveway is $25. 00 (Not Refundable) 2. Driveway Permit Security Deposit Fee of $500 . 00 (Refundable with Approved Inspection of the Driveway after completion of driveway) (Check, Money Order, or Cash will be held by the Town Treasurer until the Inspection of the Driveway is completed by Town Board. 3 . Erosion Control Plan (during Construction) must be written to the within 90 days after beginning construction of the driveway. 4 . Is an Engineers Plan Necessary? yes x no; If necessary is the Plan approved by the Town Board? x yes no Date of approval by the Town Board 2 / 3 / 9C • 5. Are any of the Specifications of the Driveway Construction, as denoted in the Driveway Ordinance Waived? If so list the letters (a) thru (p) that are waived. , , '/ O t , . dThe Above Application is hereby been approved by: '/t Town Boa Signature Note: ( below must be completed ) Chairman or Supervisor TOWN BOARD ' S INSPECTION OF COMPLETED CONSTRUCTION OF DRIVEWAY 1 . IS THE DRIVEWAY CONSTRUCTED IN ACCORDANCE WITH APPLICANT PLANS THAT WERE APPROVED BY THE TOWN BOARD. YES NO 2. THE APPLICANT WILL MAKE ANY CORRECTIONS IN CONSTRUCTION BY / / To: Applicant and Dane County Zoning tt:t FINAL APPROVAL SIGNATURE OF TOWN BOARD X Town Chairman or Supervisor * ( Building Permit may be issued upon final approval signature above )