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TOWN OF CROSS PLAINS DRIVEWAY PERMIT APPLICATION DATE: (c- ;c - \' I.CONTACT INFORMATION - To be Completed by Applicant: Name and current address Ft-,,,.,e,` i t, iy-TDtr'c irl P„,, i # C 7 t; 1- c `-i-(15.,)--)-, , of applicant 5 1N-COL _-((,"4\Llt3r■Cl 1.T,5 i 11v. 4 J te'r.o,.�3,..,—,,:--li 3.;v+,L.._,iw.. (c,,S}ruei'-K Current telephone number: work home '4.4. 1-.., )- 733.) 668 ��s �yJS Driveway location in Cross Plains: Location: west east south north side of Sec. Parcel number: c ,-.i- C fq -ci ,;t L• Contact Town Chairman,#798-0189,to arrange a site visit. Please attach a drawing of the driveway location discussed at the site visit and return to the Town of Cross Plains,3734 County Road P, Cross Plains,WI 53528, Phone (608)798-0189 as soon as possible after the site visit. II. CONDITIONS-To be completed-by Town Boar member or its agent: Width of driveway: feet NI_a mum grade of 12 o Drainage culvert needed: no I yes If culvert required, must Ttet Driveway Co struction Guide standards. Agricultural use only: V no yes Shared driveway agreement required: no yes Other requirements: 1. Shall comply with town private road ordinance and driveway construction guide for new driveways. 2. Shall contact Town Patrolman before starting construction of the driveway. 3. No Town Building Permit or Dane County Zoning Permit shall be issued until Driveway Permit Part 1 AND Part 2 has been issued. 4. ********************************************** * ************** ** *** III.APPROVAL— Date Approved By Town Board i4ate Issued: 1 q 1G The Driveway Permit is valid for one year from date of approval. The Driveway Permit is pending recordation of the Certified Survey Map at Dane County Register of Deeds Permit: Part 1 Driveway Permit Part 2 Single Residence S200.00 Fee f sc • .'.n') L ) Reminder: Please check with Dane Co. Land and Water Resources Dep. ment on soil erosion permits to see if required. , (th ,. 6, -)aj...,...,,,,,,,s2- ._,.. ..9 . - oi6\ \.9 ,, rr•