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; Dane County Department of Public Works, Highway and Transportation <br /> 9 .` �� ., PERMIT TO WORK IN <br /> .se '7 COUNTY TRUNK HIGHWAY RIGHT-OF-WAY <br /> This permit is required and shall be issued in accordance with the provisions of Section 83.027 of the Wisconsin Statutes and Chapter 79 of the Dane <br /> County Code of Ordinances. <br /> ;.-AP PEW-Mr INFORMATION, . _ = ___ _ <br /> Company Contact Name E-Mail Address <br /> Town of Verona Amanda Arnold aarnold@town:verona.wi.us <br /> Address City State Zip Code <br /> 335 N Nine Mound Road Verona WI 53713 <br /> Office Phone Alternate Phone Fax Number <br /> (608)845-7187 (608)845-7143 <br /> CONTRACTOR INFORMATION : ....'_: M <br /> Company Name Contact Name E-Mail Address <br /> JP Cullen Nick Herr nick.herr@,jpcullen.com <br /> Office Phone After Hours Phone(Required) Fax Number <br /> (608)777-0100 (608)751-9203 <br /> PR.OPOSED=WORK _ <br /> - ��.��, tip .�:� Viji-... V ,.�� <br /> County Trunk Highway where r-o-w is located n Town ❑Village ❑City of: <br /> PD Verona SW 1of NW s ction 6 <br /> Plans Prepared By Copy Enclosed? Customer Reference No (optional) <br /> Nathan Lockwood p Yes D-No <br /> Estimated Starting Date Estimated Completion Date Area to be restored 45 days Will pavement,sidewalk or curb be <br /> disturbed?(check all that apply) <br /> 05/23/2016 07/2312016 after completion of construction. ❑ Pavement ❑ Sidewalk M Curb <br /> Describe Type of Utility Installation <br /> Driveway install includes curb cut and terrace grading. <br /> CALCULAT1ON'OF PERMIT FEES ; _.. ,;. i. _QTY : AMOUNT-{ <br /> a. Permit to work in highway right-of-way 1 @$55* 55.00 <br /> b. Borings 0 @$45 per boring 0.00 <br /> c. Open cut pavement 0 @$220 per open cut 0.00 <br /> d. Trenching in excess of 1,320 feet 0 @$110 X lineal feet/1,000 0.00 <br /> e. Construction of vault or other structure 0 @$110 per vault/structure 0.00 <br /> f. Construction improvements at intersection with a highway 0 @$1,100 0.00 <br /> *This fee applies in all cases,with the exception of an application where item f above is the TOTAL FEES 55.00 <br /> only type of work planned. in this case,the$1,100 fee alone applies. <br /> Fees paid in full on 05/17/2016 <br /> PERMIT APPROVAL BY DANE COUNTY: COUNTY PERMIT NO 16U058 , <br /> The permit is hereby approved and issued by Dane County subject to full compliance by the Applicant with all provisions and conditions of the <br /> application and the additional special provisions listed below and on the reverse side hereof and all attachments hereto. <br /> This permit is contingent on all other Local,State and/or County Agency permits and approvals and applicant must comply <br /> with all federal,state and local laws,ordinances and regulations.All work shall be as per the attached plans. <br /> Traffic Control shall be in accordance with the MUTCD. Lane closures if required shall be limited to the non-peak traffic <br /> hours of 8:30 a.m.to 3:30 p.m. <br /> By <br /> 'j <br /> 05/19/2016 <br /> ature of Dane County Repre t <br /> _ ative Date <br /> Greggar Petersen Highway Engineer 608-266-4036 <br /> Print Name and Title Phone <br /> Page 1 of 2 <br />