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tr <br /> • <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 JO / v / / tr <br /> NAME OF APPLICANT /4'P cR.4/11 Y A./Lj ziWg i° <br /> ADDRESS OF APPLICANT /‘l3' rae. <br /> PHONE NUMBER f.?2 _ 6 d 2? <br /> LOCATION OF DRIVEWAY C.-MSc/ <br /> Applicant agrees with the following requirements of the Town of Primrose Driveway Ordinance and <br /> Application G,, fl c -J- <br /> APPLICANT'S SIGNATURE; fie__ 4 /' _ , l xt/S157T1,e <br /> I <br /> 1. Payment of required Driveway fee of$250.00 payable to Town of Primrose <br /> 2. Payment of required Driveway Bond Fee of$500.00 that is refundable upon 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 ix <br /> 4. Engineering Plan(prior to construction)must be in writinkand given to the Town <br /> Required YES NO k <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 /> q ' ". <br /> .• <br /> Dated this g-1 day of C t supervisor <br /> Year of 0©o g x <br /> Supervisor <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 />