DCPZP-2009-00041 - Laserfiche WebLink

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Feb. 17. 2009 8 : 53AM No. 1724 P. 3 • • Dane County Highway and Transportation Department • ACCESS PERMIT This application and permit is required and shall be issued in accordeuce with the provisions of Section 83.027 of the Wisconsin Sttitates and Chapter 7p of the Dane County Code of Ordinances. Applicant Is to complete all of the following requested Information(papso ); John )3eetham CCounty c Trunk Is Highway to CTH–MM Name A drese Oregon Wi. City �– 53575 State Zip lie a hone 256_2313 Work Phone PAX Ilixxlisst'ingAccess7: If.yes,how modified?(check one): _ Eiffel; Q No .17]Relocated ©Removed ❑Change of U130 Culvert replace ©Asphalt Paving DescribeUso: ante from old homestead to middle of two new developed lots, Location(check one): 53 Town ❑Village ❑City of Rttland Section 19 Name ofHighway and North/South/East/Westside: Gast ei.de of CTFI–MM Name of•nearast cross road; _ Rsmtr_Corners Distance and direction from nearest cross road: 1 rth of Rome Corners Existing Zoning; ,1 excl. Zoning meets Intended use?: 0 Yes t No e of Permit Requested(refer to reverse side for explanation of controlled and non-controlled access): $100 Pompdrary Controlled Access $70 Temporary Nan•Controlted Access 0 0$100 Agricultural Controlled Access a$70 Agricultural Non-Controlled Access $100 Residential(single family)Controlled Access Q$70 Residential(single family)NonrControlled Access $200 Residential,Joint Access}1 parcel 0$200 Commercial,{ $1,00.0.Private/Public,New/Existing,Street or Road 100 and $500 Commercial, and<1,000:ADT ❑$40 Miscellaneous ©$1,000 Commercial,>1.000 ADT "AD?denotes Average Daily 7}.q 7o. Data substantiating ADT for access or road intersections may be required, Checker money order In the amount of Y 00.00 ,payable to the Dane County Highway and Transportation Department Is enclosed. Cash will only be accepted in person. Do not send cash in the mail. The applicant undorstanda and agrees that the permitted work shall comply with all permit provisions and conditions listed on the reverse Al,-hereof,any special provisions listed below or attached hereto,and any and all plans,details or notes attached hereto and, -,e a part there f. Propo ,, •wner is responsible for notifying Dane County,of any conditions and/or restrictions. By ( Date 6/2/06 ' Si:•'lure of Appllcant/Represontative • NOTE: Application should be eccompauied with plans or pia;or CSM when appropriate. Application fee must accompany all applications, Applications to be submitted to Dane County Highway and Transportation Department,2302 Fish Hatchery Road,Madison, W1 53713. Contact the Assistant Commissioner at 266.4036 or Engineering office at 266.4037 with eny questions. a canto hie a de a e alt m ea a decision to th Da out ra art tm Committee, ��LY.��1Le-t1. DO NOT WRITE OR TYPE BELOW THIS LINE-.l7OR DANE COUNTY USE ONLY PERMIT APPROVAL BY DANE COUNTY COUNTY PERMIT EER{ _(-10 The foregoing applleation is hereby approved end permit issued by Dane County subject to Hill compliance by the Applicant with all provisions and conditions stated herein and an the.reverse side hereof and all attachments hereto, Other Speolel•lrovisions: . • Access grtmted to serve two single family home sites. The access to be removed at old farmstead location and relocated to center anew two lot CSM A##18 culvert pipe required 30 feet in length with apron endsection will be required. This permit is contingent upon all other local,county and state permits and approvals. • �.4 ,. By �. 4.--1y-pvp Signature of D• ' Coun r epresentative Date By 4. -'►//4/L_.'. . a) , '. Title - — Phans