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17. ®Yes ❑No Is the property zoned? Provide documentation-from_the jurisdictional zoning authority;
<br /> 18. Explain how the land is currently being used: vacant land
<br /> 19. ®Yes ®No Are you aware of any plan to change the zoning or land use We will place a deed restriction on both parcels conditional
<br /> for the property't ifyes,explain.
<br /> upon approval.Currently,two parcels that will be restricted
<br /> into one.
<br /> 20. 0 Yes ®No Is this connection for property that was part of a land division
<br /> or assemblage created on or after 2/1/99? If yes,explain.
<br /> 21. 0 Yes ®No Do you own other property abutting the highway that is next
<br /> to the property that this connection will serve? If yes,
<br /> describe.
<br /> Note 1:Answering'yes"to#20 or 21 may result in a Wis.
<br /> Administrative Code Trans 233 review by WisDOT.If this is
<br /> needed,the processing of your application may be delayed.
<br /> 22. ❑Yes ®No Does the property abut or border another public road? If
<br /> yes,provide the road's name.
<br /> 23. ®Yes 0 No Are there any existing connections serving the property? if yes,how 1
<br /> many?
<br /> 24. ($'Yes (I No Are there any restrictions on the number,use,or location of connections to the propertyt t Ros o;n1- a,llot.�eel
<br /> s p
<br /> 25. ®Yes ❑No Are there any access easements across the property(recorded or unrecorded)?
<br /> Note 2: if you answered'yes"to#24 or 25,provide a copy
<br /> of all documents relevant to the restrictions and/or
<br /> easements
<br /> 26. Provide the property tax identification 028-0610-221-8500-9
<br /> number:
<br /> 27. What is the proposed construction completion date for the connection? See Conditions of Issuance
<br /> #9.
<br /> September 1,2015
<br /> FOR ANY NEW CONNECTION OR CONNECTION TO BE MOVED, APPLICANT SHALL PLACE A FLAG OR MARKER IN THE
<br /> HIGHWAY DITCH OR FORESLOPE(VISIBLE FROM THE HIGHWAY)AT THE PROPOSED LOCATION.
<br /> CONDITIONS OF ISSUANCE
<br /> 1. WisDOT reserves the right to make such changes,additions,repairs,relocations and removals within statutory limits to the connection or its appurtenances on
<br /> the right-of-way as may at any time be considered necessary to facilitate relocation, reconstruction, widening, and maintenance of the highway,or to provide
<br /> proper protection to life and property on or adjacent to the highway,or if alternative access to the property becomes available.
<br /> 2. Except in cases where the Indicated connection may be constructed by forces acting on behalf of WisDOT due to a highway improvement or maintenance
<br /> project,the permittee shall do at of the following: (a)Furnish all materials,do at work,and pay all costs for the construction and maintenance of the connection
<br /> and its appurtenances on the right-of-way.Materials used and the type and quality of the work shall be appropriate for the connection type specified In this permit;
<br /> (b) Do all work without jeopardy to, or interference with, traffic using the highway; (c)Promptly restore to WisDOTs satisfaction and at least pre-existing
<br /> conditions,highway surfaces,shoulders,ditches,vegetation,drainage appurtenances,guardrail,signs,electric conduits/cables,etc.disturbed by any world (d)
<br /> Maintain the connection and its appurtenances within the right-of-way limits,which includes keeping them in a proper state of repair,preventing the blockage or
<br /> impairment of right-of-way drainage,and preventing aboveground obstacles to occur that could cause serious injury or death to a motorist in an errant vehicle; (e) •
<br /> Not disturb or cause the disturbance of any survey marker without the prior written to ove(of vlrisDOT.
<br /> 3. The permittee,indicated on the reverse side,represents all parties in interest,and agrees that any connection or approach constructed by or for the permittee
<br /> is for the purpose of obtaining access to the property(listed in#28)and not for the purpose of parking or servicing vehicles, or for advertising, storage, or
<br /> merchandising of goods on the right-of-way.
<br /> 4. The permittee shall not make any changes to the connection,Its appurtenances,or adjacent right-of-way,including,without limitation,changes to the location
<br /> (#4-11),use(#13),width(#14),surface(#15),or increase the number of trips per day(#18)approved by this permit without obtaining prior written asorovat from
<br /> WisDOT.WisDOT will evaluate all potential highway impacts that may arise from the proposed change(s)and therefore,does not guarantee approval.
<br /> 5. The permittee,successors or assigns agree to hold harmless the State of Wisconsin and its duly appointed agents and employees against any action for
<br /> personal injury or property damage sustained by reason of the exercise of this permit
<br />
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