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TOWN OF PRIMROSE <br /> DRIVEWAY PERMIT APPLICATION <br /> (DANE COUNTY ZONING PERMIT ISSUED ONLY AFTER FINAL INSPECTION BY THE TOWN BOARD) <br /> APPLICATION DATE: 1 r n 1d.V`cI 18 , Z 01 <br /> APPLICANT NAME: N A u 1,1 Be ekv- They or 4, a 16 4E ln. O <br /> APPLICANT ADDRESS: PAI 2L #0507- III --60/O- / , /Jy .BIZ , Vevavtr..t__ <br /> PHONE NUMBER: Co D�-a I "'Coln S 1p <br /> LOCATION OF DRIVEWAY: 0iZ to batt,lArQaAni.` o F' p c.e 2 <br /> ---N <br /> Applicant agrees with the following requirement' of th T of Primrose Driveway Ordinance and <br /> application. ( ----- <br /> L <br /> APPLICANTS SIGNATURE: -a/ V <br /> 1. Payment of required Driveway Fee of$250.00 Payable to the Town of Primrose <br /> 2. Payment of required Driveway Bond Fee of$500.00 that is refundable upon compietn n lied <br /> approved inspection of the Driveway. J ,`r 6,- <br /> (refund is made assuming 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 If Waived,which <br /> Items of(a)through(p). , <br /> The above application is hereb a• •roved by: x p <br /> , Pity To Chairman <br /> Dated this L/ day of - �./ x ^Il . Ii <br /> Year of 2O/ Supervisor <br /> x <br /> Supervisor <br /> Ton Board Inspection of Completed Driveway <br /> 1. Driveway is constructed in accordance with the applicant's plans that were approved by the <br /> Town Board. <br /> l <br /> ES NO <br /> 2. Any corrections in the co struction 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 UNLESS SIGNED BY TOWN <br /> CHAIRPERSON AND SUPERVISOR ABOVE. <br />