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• Dane County Department of Public Works, Highway and Transportation <br /> ACCESS PERMIT <br /> This permit is required and shall be issued in accordance with the provisions of Section 83.027 of the Wisconsin Statutes and Chapter 79 of the Dane <br /> County Code of Ordinances. <br /> Name Co.Trunk Hwy in which access is requested: <br /> Dan Kok D <br /> Street Address Town,Village,City Section <br /> 2921 Camp Leonard Road Town of Oregon 8 <br /> City State Zip <br /> McFarland WI 53558 <br /> Home Phone Work Phone Fax Number E-Mail Address <br /> (608)576-6225 (608)576-6225 Dan@dankok.com <br /> Existing Access? If yes,how modified? <br /> Yes ❑ Relocated ❑ Removed © Change of Use ❑ Culvert Replace ❑ Asphalt Paving <br /> Describe Use: <br /> Joint use <br /> North/South/EastNVest Side Nearest Cross Road Distance&Direction of nearest cross rd Existing Zoning: Meets Intended Use? <br /> South Storytown Rd 1,300 feet east A-1(ex),&LC-1 Q Yes ❑ No <br /> Type of Permit Requested: <br /> ❑ $110 Temporary Controlled Access ❑ $75 Temporary Non-Controlled Access <br /> ❑ $110 Agricultural Controlled Access ❑ $75 Agricultural Non-Controlled Access <br /> ❑ $110 Residential(single family)Controlled Access II $75 Residential(single family) Non-Controlled Access <br /> • $220 Residential,Joint Access> 1 parcel Li $220 Commercial,<100 ADT** <br /> L $1,100 Private/Public, New/Existing,Street or Road 1._1 $550 Commercial,>1000 and<1,000 ADT <br /> ❑ $45 Miscellaneous ❑ $1,100 Commercial,>1,000 ADT <br /> "ADT denotes Average Daily Traffic. Data substantiating ADT for access or road intersections may be required. <br /> Fees paid in full on 3/112013 <br /> PERMIT APPROVAL BY DANE COUNTY COUNTY PERMIT NO. 13A001 <br /> The application submitted is hereby approved and this permit is issued by Dane County subject to full compliance by the Applicant with all provisions <br /> and conditions stated herein and on the reverse side hereof and all attachments hereto. <br /> Other Special Provisions: <br /> This permit is contingent on all other Local,State and/or County Agency permits and approvals. The existing culvert with <br /> endwalls meet current driveway standards. No modification to the driveway are required. <br /> Check#2627 <br /> BY �� _l am 4 3/18/2013 <br /> nature of Dane County Representative Date <br /> reggar Petersen Highway Engineer 608-266-9081 <br /> Name and Title Phone <br /> Page 1 of 2 <br />