DCPZP-2009-00313 - Laserfiche WebLink

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-- �..w=v +1.464uway a iu r ransponanon i..tepartment ACCESS PERMIT • This application.and.permit is required and shall be-issued in accordance with the provisions or Section'83.027 of the • Wisconsin Statutes end Chapter'79 of the Dane County Code of Ordinances. ' Applicant Is to complete all of the following requested Information(please urint or runt): . County Trunk Highwry.to which access Is requested: Name' / Address - ,—�• • • State Zip. . (6.t )379."'"4(52, • . 0P --1`" 7#01 Q3 7 7�q7. - Home ono , Work Phone FAX Exitting'Aecess?: ' If yes,how Modified?(check one): ••.Yes• []No URelocated ' Q Removed •,[]Change of use • 0.Culvert replace heltPa • •Describe Use: -- At +i' ram: ving : Loatioti.(checkone):•;;Town. • ' Villa e. CIt - of r t []• ' Y �G)OQc�^ ��.ZAl:S' • Section 3,z ' Name of RigliWay and Ne • '.11 iit/Westside: ', C I H S ' ., •• •Nellie of ne aresf cross road:. 7 /M C.0� /904�� ` Dbstanee•and.dkectiof from nearaet.cross road: 9Ji el-Ay l o j,r 'A�).97••'Existing Zoning; , .. Zoning meets intended use?: ❑Yes' , 0 No - .'rypeof,PennitRequ ted(refer.to.reveneside for explanation of controlled and non-oontritUed access): • j$50 Temporary Coiitrglled Arms! 0 535 Temporary Non-Controlled Access ... . 0 S50 Agricultural Controlled Access • O S35 Agricultural Non-Controlled Access ,Q'SS0 Residential(single family)Controlled Access 0$35.Resldential(single family)Non-Controlled Access . $100 Residential(multi-family)Access 0 5.100 Commercial,<10b•ADT'•' • • ❑•S5o0 Privat&Pnblic.New/Bxisting,.8treet or Road .O$250 Commercial,>100 and 41;'000 ADT • []S20•Miscelleneous .. ©$500 Commercial,>1,000 ADT "ADT denotes Average Daily.T affic..Data substantiating ADT for,aecess or road intersections may be required.' • Check or money order in the amount of l c'o./�,payable to the Dane County Highway and Transportation Department is enclosed..Cash will only be accepted In person. Do not seed cash in the mail • • • The aPplteant•undeertande and agrees that-the,peintitted 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 ell plans,details or notes attached hereto and made a part thereof. Property owner is responsible for notifying Dane County deny conditiops'and/or ra5rictlon3. By• j.,,.,0 C°.� ..-t ' Date /2 9"p q • ,,o. iggoatureofApplicant/Representative ' NOTE: Applieation should be accompanied with plans or plat or CSM when appropriate. Application feet must:accompany • all applications. Applications to,be submitted to Dane County Highway.and Transportation Department,2302 Fish Hatchery Road,Madison,WI 13713. Contact the Assistant Commissioner et,266-4036 or Engineering office at 266-4037 with any' DO NOT WRITE•OR TYPE BELOW THIS LINE--FOR DANE COUNTY USE ONLY • • PERMIT APPROVAL BY DANE COUNTY COUNTY PERMIT NUMBER: p3 U.-651 The foregoing application ii:hereby appmvod 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. . OtherSpecial Provisions: • . .• The access is located directly acreas from Garfoot Rd. Construct end walls on each end of the canting culvert. This access permit is contingent on Town Board Approval and other required Permits and Approvals. This access permit is contingent op proper zoning of this property. • • +o • • By J !z-Si 3 Signature ofDat►e County presentetit±eto BY r - 264-4/44/ . Phone ' ''"he'maai -Page I oft • ■AdtrMRminy.m.1110. ,1.M • t00/ZOOlTh %vd TZ:ST Hill C00Z/60/ZT 711? o 1 •n 1 (on 1 1 erara7-era-nun slur I/assn X14