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• <br /> TOWN OF PRIMROSE <br /> DRIVEWAY PERMIT APPLICATION <br /> ***TO DANE COUNTY COUNTY ZONING: ZONING PERMIT MUST NOT BE <br /> ISSUED UNLESS SIGNED BY TOWN CHAIR OR SUPERVISOR <br /> DATE y //lo j / 0 8 <br /> NAME OF APPLICANT na Y'D/c <br /> �" 1� <br /> ADDRESS OF APPLICANT /5:? C4—if � /,v r <br /> • }a 1� /41-1-,i75-7,2 <br /> PHONE NUMBER '&7 <br /> LOCATION OF DRIVEWAY 5, 1/1'6: <br /> Applicant agrees with the following requirements of the Town of Primrose Driveway Qrdinance and <br /> Application p / <br /> ► 1 , ,1 <br /> APPLICANT'S SIGNATURE' 'l11.g> J & i lI��-4J. <br /> • 1. Payment of required Driveway fee of$250.00 payable to Town of Primro <br /> 2. Payment of required Driveway Bond Fee of$500.00 that is refundable upo completion and <br /> Inspection of the Driveway <br /> • 3. Erosion Control Plan(during construction)must be in writing and given to the Town <br /> Required YES NO 7 <br /> 4. Engineering Plan(prior to construction)must be in writing and given to the Town <br /> Required YES NO X <br /> 5. Specifications of the Driveway Construction,as denoted in the Driveway Ordinance, <br /> If waived which items of(a)thru(p) <br /> The above application is hereby approved by x <br /> 4' x ` fir_411W <br /> Dated this 1 $ day of <br /> Year of 60 11411, <br /> AP S rvisor <br /> TOWN BOARD INSPECTION OF COMPLETED DRIVEWAY <br /> 1. Driveway is constructed in accordance with the applicants plans that were approved by the <br /> Town Board <br /> YES NO <br /> 2. Any corrections in the construction of the Driveway must be completed by: <br /> IF TOWN HAS NOT BEEN CONTACTED WITHIN 2 YEARS TO INSPECT THE <br /> COMPLETED DRIVEWAY,BOND MONEY WILL BE ADDED TO THE GENERAL <br /> ACCOUNT. <br /> APPROVED x x DATE <br /> Town Chairman Supervisor <br />