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TOWN OF CROSS PLAINS DRIVEWAY PERMIT APPLICATION <br /> DATE: I Off Q/.214 <br /> I. CONTACT INFORMATION-To be Completed by Applicant: <br /> Name and current address .1-a si-iti 7. aoz wi A. <br /> of applicant <br /> r / L //j <br /> "1337 W/rn YAPt, rfasr Pl acca ✓ j "A'C7/,5p% 1t/`• <br /> Current telephone number: work 601 332-07$2 home~ h 'f- 3 3`! -.704 <br /> Driveway location in Cross Plains: 97,47 &I'i +kr//er it d <br /> Location: west east south north side of Sec. al, <br /> Parcel number: ("5A9 1 1 149 <br /> Contact Town Chairman,#798-0189, to arrange a site visit. <br /> Please attach a drawing of the driveway location discussed at the site visit and return to the Town <br /> of Cross Plains,3734 County Road P, Cross Plains,WI 53528,Phone (608)798-0189 <br /> as soon as possible after the site visit. <br /> II. CONDITIONS-To be completed by Town Board member or its agent: <br /> ier( <br /> Width of driveway: It( feet Maximum grade of 12%. <br /> Drainage culvert needed: no yes 1�� <br /> If culvert required, must eet Driveway Construction Guide standards. • <br /> Agricultural use only:)no yes <br /> Shared driveway agreement required: no )(... yes k^.- t <br /> Other requirements: <br /> 1. Shall comply with town private road ordinance and driveway construction guide for new <br /> driveways. <br /> 2. Shall contact Town Patrolman before starting construction of the driveway. <br /> 3. No Town Building Permit or Dane County Zoning Permit shall be issued until Driveway <br /> Permit Part 1 AND Part 2 has been issued. <br /> 4. <br /> ********************************************** * ************* ** ** <br /> III.APPROVAL-Date Approved By Town Board: 6 •/ _I ate Issued: j �� 1( <br /> The Driveway Permit is valid for one year from date of approval. <br /> The Driveway Permit is pending recordation of the Certified Survey Map at Dane County <br /> Register of Deeds <br /> Permit: Part 1 Driveway Permit Part 2 Single Residence <br /> $200.00 Fee V 2Q - <br /> Reminder: Please check with Dane Co. Land and Water Resources Department on soil e 1 ion <br /> permits to see if required. <br /> t �� <br /> e.-Nol<• 'k 0 .! 11 1 <br /> @\t‘ yfr ' <br /> Q■0_1.1-311 • <br />