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DOCUMENTATION OF AUTHORIZED CONNECTION TO STATE TRUNK HIGHWAY Wisconsin Department of Transportation(WisDOT) DT2234 6/2006 s.84.25 Wis.Stats. • This form is NOT a permit. It serves to document an STH connection regarding its it; z type, configuration, drainage, etc.,for a property in which WisDOT authorized an LL ° Wisconsin DOT access point under a previous s.84.25,Wis. Stats. project. O < SW Region Madison Office • Use only one DT2234 form for each connection. When work in the highway right-of- O o 2101 Wright St. way is also needed, use form DT1812 together with form DT2234. z Madison,WI 53704 • Please include a copy of the property deed. 1.Property Owner Name and Mailing Address-Street/PO Box,City,State,ZIP Code 2.Property Owner Area Code+Telephone Number Matt Hamacher (608)212 8919 ° PO Box 302 Stoughton WI 53589 W p 3. Property Owner E-Mail Address o 14. matth @hamacherlawncare.com a 4.Highway Number(s) 5.County 6. ❑City ❑Village ®Town 7.Side of the Highway 138 Dane of: Ruland ❑ North Z South ❑ East ❑West a C0 8. Located within the 9. Fire or Street Number(If applicable) J t- 0 NW Quarter, of the NE Quarter, Section 12,Town 5 North, Range 10 East 3279 a 10.Name of Nearest Side Road from Location Distance and Direction from Side Road 11.How far is the location from the w z 2750 ft West nearest non-side road connection 135 ft z USH 51 2,750 on the same highway? o (Feet or Miles) (N,S,E,W) (Feet or Miles) • Log Mile or Reference Point(Completed by WisDOT): RP= 011 M+0.52 w 12. Proposed Activity 13.Proposed Use(Check one) 16.Proposed Trips Per Day(Check one) • z (Check one) >- ° ❑ Urban-Commercial/Industrial ❑ Rural-Agricultural ❑ Seasonal ❑ 101-1000 z a ❑ Urban-Residential ❑ Public Road Z 1-50 ❑ Over 1000 R. 2 ❑ Construct New ® Rural-Commercial/Industrial ❑Trail or Trail Crossing ❑ 51-100 ❑Alter Existing w o ❑ Rural-Residential ❑ Remove Existing Peak hour traffic count: z z Is this a change of the existing use(If applicable)? Z Yes ❑ No o — Z Document Existing U 14. Proposed Width: N/A 115. Proposed Surface: existing 17. Z Yes ❑ No Is the property zoned? Include documentation from the jurisdictional zoning authority. 18. Explain how the land is currently being used: Rental Property&6 acres of tillable farm land 19. 0 Yes ❑ No Does the property owner have any plans to change the zoning Rezone to create 1 residential lot and 1 Light Commercial or land use for the property? If yes,explain. lot for lawncare Business rNote:Items 20 and 21 purposely omitted 22. ❑Yes 0 No Does the property abut or border another public road? If yes, provide the road's name. 23. ❑Yes Z No Are there any existing connections serving the property? If yes,how many? 24. ❑Yes Z No Are there any restrictions on the number,use,or location of connections to the property? If#24 or 25=yes",have copies of all documents relevant 25. ❑Yes Z No Are there any access easements across the property to the restrictions and/or easements been provided? (recorded or unrecorded)? 26. Provide the property tax identification number: 052-0510-121-8600-1 ❑ Temporary. Expiration date: SEE BACK PAGE FOR Identification Number ❑ This voids/replaces permit number: CONDITIONS OF ISSUANCE 13-100197407-2015 ❑ Shared Co-user name: r connection Related ID number: X `� -!% 11/02/2015 File: (WisDOT Authorized Representative) (Date) (If Computer-filled,Brush Script Font)