DCPZP-2009-00448 - Laserfiche WebLink

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Dane County Department of Public Works,Highway and Transportation / . • ACCESS PERMIT This application and 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 County Code of Ordinances. Applicant is to complete all of the following requested information(please print or type): l3rt �Y j,G,( �� /�� County Trunk Highway to i which access is requested: Name 1��tS gir(-1,-. l� / c C::.ter;:4r nJ Ai,g,„lrJ 4 Address L-U lv 0 i,) i s 14.),,J 5Y5/ 7 City State Zip (60 ) 1-137- -7J(✓2 2zs-- 6`7 ' eq ."g 2,Y 7 j,,,.: ; 0 !4 •:-t=c,, hey' Home Phone Work Phone FAX E-Mail Address Existing Access?: If yes,how modified?(check one): qYes ❑No 0 Relocated 0 Removed Change of use ❑Culvert replace ❑Asphalt Paving Describe Use: 12i V‘1„JAy �',t IVi lhl Roos E; Location(check one): JZI Town 0 Village 0 City of S'g 1:J5 16 Section i,L1 Name of Highway and North/((South/East/West side: C I y )I t'J y - Name of nearest cross road: 1.s7`i kvri y po Distance and direction from nearest cross road: I 1IZ. M 1 p�r , nr PL) Existing Zoning: loc i 0 6r f--"i, Zoning meets intended use?: S2,Yes 0 No Type of Permit Requested(refer to reverse side for explanation of controlled and non-controlled access): ❑$110 Temporary Controlled Access ❑$75 Temporary Non-Controlled Access ❑$110 Agricultural Controlled Access ❑$75 Agricultural Non-Controlled Access ❑$110 Residential(single family)Controlled Access ❑$75 Residential(single family)Non-Controlled Access ).$220 Residential,Joint Access>1 parcel ❑$220 Commercial,<100 ADT** ❑$1,100 Private/Public,New/Existing,Street or Road ❑$550 Commercial,>100 and<1,000 ADT ❑$45 Miscellaneous ❑$1,100 Commercial,>1,000 ADT **ADT denotes Average Daily Traffic. Data substantiating ADT for access or road intersections may be required. Check or money order in the amount of ,payable to the Dane County Department of Public Works,Highway and Transportation is enclosed. Cash will only be accepted in person. Do not send cash in the mail. The applicant understands and agrees that the permitted work shall comply with all permit provisions and conditions listed on the reverse side hereof,any special provisions listed below or attached hereto,and any and all plans,details or notes attached hereto and made a part thee447,./rreof. Pop owner is responsible for notifying Dane County of any//conditions and/or restrictions. By Date O/3 cil z.00-7 Signature f Applicant/Representative NOTE: Application should be accompanied with plans or plat or CSM when appropriate. Application fee must accompany all applications. Applications to be submitted to Dane County Department of Public Works,Highway and Transportation, 2302 Fish Hatchery Road,Madison,WI 53713. Contact the Assistant Commissioner at 266-4036 or Engineering office at 266-4037 with any questions. Any applicants which are denied a permit may appeal the decision to the Dane County Public Works and Transportation Committee. DO NOT WRITE OR TYPE BELOW THIS LINE--FOR DANE COUNTY USE ONLY PERMIT APPROVAL BY DANE COUNTY COUNTY PERMIT NUMBER:O -0 0 9 The foregoing application is hereby approved and permit issued by Dane County subject to full compliance by the Applicant with all provisions and conditions stated herein and on the reverse side hereof and all attachments hereto. Other Special Provisions: This access permit is contingent on Town Board Approval and other required Permits and Approvals. This access permit is contingent on proper zoning of this property. ii Q By . �L— y- E - b / ture of Dane County Representative Date By �o� S 9; A-fr /�e e� 408)_21(‘-- 0.Y/ Title Phone :0/+ 7.111 PM Page 1 of 2 http:/Mein cuo,Io,dsrmsemarc,, guecu-sv->oo7.doe