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• - Dane County Department of Public Works, Highway and Transportation ACCESS PERMIT This application and 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 County Code of Ordinances. Applicant is to complete all of the following requested information(please print or type): County Trunk Highway to lta2oLz sci4 L M.G Elu which access is requested: L7 Name 15-3-3 4 CT t-f . 6 So'.X i-4 Address MT. Hot LI /A22- 5-35'72_ City State Zip Y37-3%7Z- 437-..?!7z Home Phone Work Phone FAX Existing Access?: If yes.how modified? (check one): JZYes — No Relocated _ Removed g Change of use ❑ Culvert replace ❑ Asphalt Paving Describe Use: S FA-rA.IL R.,F S i DE,1(c G Ani U AG21664.4,71-t2,4-(.- Location(check one): eE Town ❑ Village City of ?R.l kkR_osC. Section l!7 Name of Highway and North/South/East 'est sid• CT --v Name of nearest cross road: 13 RC(TT VA LL F Y R oA D Distance and direction from nearest cross road: ( qZ0 /43Q..1 t} Oil' tRl-ri vkOCI✓ ' QA. Existing Zoning: Zoning meets intended use?: Yes ` No ape of Permit Requested (refer to reverse side for explanation of controlled and non-controlled access): Li $110 Temporary Controlled Access L; $75 Temporary Non-Controlled Access $110 Agricultural Controlled Access _ $75 Agricultural Non-Controlled Access $110 Residential(single family)Controlled Access $75 Residential(single family)Non-Controlled Access = $220 Residential,Joint Access> 1 parcel $220 Commercial,<100 ADT** _ $1,100 Private/Public,New/Existing, Street or Road $550 Commercial, >100 and<1,000 ADT $45 Miscellaneous $1,100 Commercial,>1,000 ADT **ADT denotes Average Daily Traffic. Data substantiating ADT for access or road intersections may be required. trO Check or money order in the amount of 7S ,payable to the Dane County Department of Public Works,Highway and Transportation is enclosed. Cash will only be accepted in person. Do not send cash in the mail. The applicant understands and agrees that the permitted 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 all plans, details or notes attached hereto and made a part thereof. Property owner is responsible for notifying Dane County of any conditions and/or restrictions. _ By Date S i e-08 Signature A pP licant:Re tative NOTE: Application should be accompanied with plans or plat or CSM when appropriate. Application fee must accompany all applications. Applications to be submitted to Dane County Department of Public Works, Highway and Transportation, 2302 Fish Hatchery Road, Madison, WI 53713. Contact the Assistant Commissioner at 266-4036 or Engineering office at 266-4037 with any questions. Any applicants which are denied a permit may appeal the decision to the Dane County Public Works and Transportation Committee, DO NOT WRITE OR TYPE BELOW THIS LINE--FOR DANE COUNTY USE ONLY PERMIT APPROVAL BY DANE COUNTY COUNTY PERMIT NUMBER: 08/4-009 The foregoing application is hereby approved and permit issued by Dane County subject to full compliance by the Applicant with all provisions and conditions stated herein and on the r, s1:e sidc v c ., herein the ..cre.��and a.� ilerero. Other Special Provisions; The access shall be located 1920'north of Britt Valley Rd. Install an(15 inch x 21 inch)x 30 foot or an 18 inch x 30 foot corrugated metal pipe with end walls. Enclosed is the"Culvert Selection Chart For Rural Private and Field Entrances." Note in the cross-section the grade must be maintained at a 2% to 6% for 30 feet.When the access is constructed contact Dan Behrend at 266- 4014 or 516-8412 to inspect the installation of the access. This access shall be used for residential and agricultural use. This access permit is contingent on Town Board Approval and other required Permits and Approvals. This access permit is contingent on proper zoning of this property. By 4 — Signature of Dane County Representative t ' ' Date S By Title Phone zz, _40 (4 !/2;2007.2:49 PM Page 1 of 2 r:\shared\form\per ohs\access•2007.doc