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`, ` Dane County Department of Public Works, Highway and Transportation <br /> ACCESS PERMIT <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 /> Name Co.Trunk Hwy in which access is requested: <br /> Gary Karls E <br /> Street Address Town,Village,City Section <br /> 10795 N. Perry Rd. Town of Blue Mounds 32 <br /> City State Zip <br /> Blue Mounds WI 53517 <br /> Home Phone Work Phone Fax Number E-Mail Address <br /> (608)437-6942 (608)219-9163 (608)7984461 qualitywestinc@gmail.com <br /> Existing Access? If yes,how modified? <br /> Yes ❑ Relocated ❑ Removed © Change of Use ❑ Culvert Replace ❑ Asphalt Paving <br /> Describe Use: <br /> Joint use for 2 residential parcels and ag lands <br /> North/South/EastlWest Side Nearest Cross Road Distance&Direction of nearest cross rd Existing Zoning: Meets Intended Use? <br /> West N Perry Rd 0.75 Miles RH-2 and AG-1 ❑ Yes © No <br /> Type of Permit Requested: <br /> ❑ $110 Temporary Controlled Access ❑ $75 Temporary Non-Controlled Access <br /> ❑ $110 Agricultural Controlled Access ❑ $75 Agricultural Non-Controlled Access <br /> ❑ $110 Residential (single family)Controlled Access ❑ $75 Residential(single family) Non-Controlled Access <br /> $220 Residential,Joint Access> 1 parcel Cl $220 Commercial,<100 ADT** <br /> ❑ $1,100 Private/Public, New/Existing,Street or Road ❑ $550 Commercial, >1000 and<1,000 ADT <br /> ❑ $45 Miscellaneous ❑ $1,100 Commercial,>1,000 ADT <br /> **ADT denotes Average Daily Traffic. Data substantiating ADT for access or road intersections may be required. <br /> Fees paid in full on 10/27/2015 <br /> PERMIT APPROVAL BY DANE COUNTY COUNTY PERMIT NO. 15A028 <br /> The application submitted is hereby approved and this permit is issued by Dane County subject to full compliance by the Applicant with all provisions <br /> and conditions stated herein and on the reverse side hereof and all attachments hereto. <br /> Other Special Provisions: <br /> This permit is contingent on all other Local,State and/or County Agency permits,zoning and approvals and applicant must <br /> comply with all federal,state and local laws,ordinances and regulations. <br /> The access must be graded to drain away from the edge of road for a minimim of 8'. An 18"diameter culvert 30 feet long <br /> with approved metal apron endwalls is required. No concrete pavement is allowed in the highway right of way. <br /> Check#17093 <br /> By 10/28/2015 <br /> e. •ture of ane County Representative Date <br /> reggar Petersen Highway Engineer 608-266-9081 <br /> Name and Title Phone <br /> Page 1 of 2 <br />