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DRIVEWAY PERMIT <br /> TRANSFERRED TO: Konni Helegson/Clint Schneider <br /> 1718 Wicklow Way <br /> Madison, WI 53711 S ti <br /> 1_ C C' <br /> TOWN OF PRIMROSE J/ j <br /> DRIVEWAY PERMIT APPLICATION "� I ���� <br /> "" (DANE COUNTY ZONING PERMIT ISSUED ONLY AFTER FINAL INSPECTION BY THE TOWN BOARD) <br /> DATE 1 I / I 0 J-00 3 pc r- /,I <br /> 1 c;'1�. <br /> NAME 0= APPLICANT i yy1 C+- tc-e_ v p,s t u d <br /> ADDRESS 317 APPLICANT 0 htL.y U <br /> PHONE NUMBER GQ1 J 4Sgj - O -1 <br /> LOC T'!,:_,N OF DRIVEWAY 0 t7 Grind/r go 'i 4 <br /> Applicant agrees with the following requirements of the Town of Primrose <br /> Driveway Ordinance and application, <br /> APPLICANTS SIGNATURE: J v-r\ <br /> 1 Payment of required Driveway Fee of $ 25.00 payable to Town of Primrose <br /> 2 Paymer t of required Driveway Bond Fee of $ 500.00 that is refundable upon <br /> comple:ion and inspection of the Driveway. <br /> (refund :s made assuming that no damage is done to the Highway fronting the drive) <br /> 3 Erosion Control Plan (during construction) must be in writing and given to the Town <br /> Required: YES NO X <br /> 4 Engineering Plan (prior to construction) must be in writing and given to the Town <br /> Required YES NO X <br /> 5 Specifications of the Driveway Construction, as denoted in the Driveway Ordinance. <br /> If Waived which items of (a) thru (p). / <br /> � <br /> C %J� <br /> The Above Application is hereby approved by x — (n;- <br /> Town Chairman <br /> x <br /> Dated -r his Id day of 4 t (/ Supervisor <br /> year of 4/ JG 5 x <br /> Supervisor <br /> Town Board Inspection of Completed Driveway <br /> Driveway is constructed in accordance with the applicants plans <br /> that were approved by the Town Board. <br /> YES NO <br /> 2 Any corrections in the construction of the Driveway must be completed by <br /> APPROVED: x x <br /> Town Chairman Supervisor <br /> DATED THIS DAY OF <br /> TO DANE COUNTY ZONING: ZONING PERMIT MUST NOT BE ISSUED <br /> UNLESS SIGNED BY TOWN CHAIR OR SUPERVISOR ABOVE <br />