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OWN OF CROSS PLAINS DRIVEWAY PERMIT APPLICATION <br /> DATE: l/ I l � (5 <br /> I. CONTACT INFORMATION-To be Complete by Applicant: <br /> Name and current address (l YYl Tic ve rs Vren Trave rs <br /> of applicant <br /> 12g19 Pcl ft n'M 105 fer .0 )a j70 <br /> Current telephone number: work home 103—C? (CV F:t4(0-1 <br /> Driveway location in Cross Plains: C: H IrtpraO POI r i- <br /> Location: west east south north side of Sec. 25 <br /> Parcel number: 020/07e:-t—62- e61O -0 <br /> Contact Town Chairman,#798-0189,to arrange a site visit. <br /> Please attach a drawing of the driveway location discussed at the site visit and return to the Town <br /> of Cross Plains,3734 County Road P, Cross Plains,WI 53528, Phone (608)798-0189 <br /> as soon as possible after the site visit. <br /> *********************************************************************** <br /> II. CONDITIONS-To be completed by Town Board member or its agent: <br /> S 'ts CAA 1M 9/NtC NOEF PRI( <br /> Width of driveway: feet Maximum grade of 12%. <br /> Drainage culvert needed: no yes f ) <br /> If culvert required,must meet Driveway Constructio vide standards. <br /> Agricultural use only: K no yes <br /> Shared driveway agreement required: no yes <br /> Other requirements: <br /> 1. Shall comply with town private road ordinance and driveway construction guide for new <br /> driveways. <br /> 2. Shall contact Town Patrolman before starting construction of the driveway. <br /> 3. No Town Building Permit or Dane County Zoning Permit shall be issued until Driveway <br /> Permit Part 1 AND Part 2 has been issued. <br /> 4. <br /> ********************************************** ' ************** ** ** <br /> III.APPROVAL—Date Approved By Town Board• �/ ate Issued: a o <br /> The Driveway Permit is valid for one year from date o approval. t , <br /> The Driveway Permit is pending recordation of the Certified Survey Map at Dane County ' <br /> Register of Deeds <br /> Permit: Part 1 D •' ay Permit Part 2 Single Residence 1■ r <br /> od <br /> S200.00 Fee 35/(0-7— 4400 is <br /> Reminder: Please check with Dane Co. Land and Water Resources Department on soil erosion <br /> permits to see if required. <br /> 9_C , . . CgayEJ ' .70-)G-f- tu <br /> fr ,D 'Aq\r) ttovrs <br /> .1.0--16 t-61( icpcitM 12-ci <br /> B L1e- Hourit 1 vv i 3c>-)I-1 <br />