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DOCUMENTATION OF AUTHORIZED CONNECTION TO STATE TRUNK HIGHWAY , • <br /> Wisconsin Department of Transportation(WisDOT). <br /> • DT2234 6/2006 s.84.25 Wis.Stets. • <br /> • <br /> • This form is NOT a permit. It serves to document an STH connection regarding its u <br /> type,configuration,drainage,etc.,for a property in which WisDOT authorized an .§ Wisconsin DOT.: . <br /> access point under a previous s.84.25,Wis.Stats.project. C,;g SW Region-Madison Office <br /> • Use only one DT2234 form for each connection. When work in the highway right-of- <br /> way t--,` <br /> Y 9 Y 9 2101 St. <br /> way is also needed,use form DT1812 together with form DT2234. z Madisl5 Wright ri Wi 53704 <br /> • Please include a copy of the property deed. .._r. <br /> 1.Property Owner Name and Mailing Address-Street/PO Box,City,State,ZIP Code • 2.Property Owner Area Code+Telephone Number <br /> z Henry D.and Tarry L.Blanke 608-212-2770 <br /> .2 5461 Daley Road <br /> <O rr <br /> 4 Waunakee,.WI 53597 . . , . <br /> o <br /> rx 3.Property Owner E-Mail Address <br /> o blanke135@centurytel.net <br /> . ' <br /> 4.Highway Number(s) 5.County 6. ❑City ❑Village ®Town 7.Side of the Highway <br /> • 14 Dane of:Black Earth ®North ❑South ❑East ❑West <br /> emu:2 8.Located whin the 9.Fire or Street Number(if applicable) <br /> g SW Quarter,of the SW Quarter,Section 25,Town 8 North,Range 6E <br /> o:z. <br /> v.o 10.Name of Nearest Side Road from Location Distance and Direction from Side Road 11.How far is the location from the <br /> n r a' nearest non-side road connection <br /> 1�8 <br /> . ^z Kahl Road 550 ft• West on the same highway? <br /> p (Foal or MNlae) (N.S.E.W) (Feet or MIT) <br /> • Log Mile or Reference Point(come44040 iMsDoTy RP=184K±0.29: , . <br /> w 12. Proposed Activity 13.Proposed Use(Check one) 16.Proposed Trips Per Day(Check one)- <br /> (Check one) <br /> F-. o ❑Urban-Commercial/Industrial ❑Rural-Agricultural ❑Seasonal ❑101-1000 <br /> .`:z•► • ❑Urban-Residential ❑Public Road ®1-50 ❑Over 1000 <br /> o_ 4- ❑Construct New <br /> r z ❑Alter Existing ❑Rural-Commercial/lndustrial ❑Trail or Trail Crossing ❑51-100 _ <br /> 0 re <br /> w o" ®Rural-Residential <br /> z a ❑Remove Existing Peak hour traffic count: <br /> x z Is this a change of the existing use(If applicable)? ❑Yes ®No <br /> o ▪ ®Document Existing <br /> V 14.Proposed Width: same 1 15.Proposed Surface: gravel <br /> 17. Yes ❑No Is the property zoned? Include documentation from the jurisdictional zoning authority. <br /> 18. Explain how the land is curreattybeing used:. <br /> 19. ❑Yes ®No Does the property owner have any plans to change the zoning <br /> or land use for the property? If yes,explain. <br /> Note:Items 20 and 21 purposely omitted <br /> • 22. ❑Yes ®No Does the property abut or border another public road? If yes, <br /> provide the road's name. <br /> 23. ®Yes ❑No Are there any existing connections serving the property? If yes,how many? 1 <br /> 24. _0 Yes ❑No Are there any restrictions on the number,use,or location of <br /> connections to the property? If#24 or 25='yes'have copies of all documents relevant <br /> 25. ❑Yes El No Are there any access easements across the property , <br /> to the restrictions and/or easements been provided? <br /> (recorded or unrecorded)? <br /> 26. Provide the property tax Identification number: 00510806-251-9001-0 <br /> ❑ Temporary. Expiration date: SEE BACK PAGE FOR la•nlncatlon Number <br /> ❑ This voids I replaces permit number: CONDITIONS OF ISSUANCE 13-4-09 . <br /> ® Shared Co-user name: Strang/Zabrowskl <br /> connection Related ID number: 13-5-09&13-6-09 X � 3/10/09 <br /> Fly: (WIsDOT Authorized Representative) (Date) <br /> (If Computer-filled,Brush Script Font) <br /> • <br />