DCPZP-2008-00725 - Laserfiche WebLink

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* :, Dane County Highway and Transportation Department — 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): 1 AOJ-t it 7 . Sandra L. d0 n . which a�'si Highway Ac Name 41 3 Couxty At(' k Address ! Oreln 6367 s' City State Zip (obi ,35q UO& 87.3 -359 9 Home Phone Work Phone FAX Existing Access?: If yes,how modified?(check one): ,®Yes ❑No Relocated ❑ Removed ❑ Change of use ❑ Culvert replace ❑ Asphalt Paving Describe Use: M U LT I- FA Mvl t L`e A CL EIS Location(check one): Er Town ❑Village ❑ City of j� of Section Name of Highway and No Sou +ast/West side: Cent 0-1-t) 4-- Name of nearest cross road: Fit 'b 12d 7A6/ 11 Distance and direction from nearest cross road: '- e-e- c-.eq Existing Zoning: Zoning meets intended use?: ❑Yes ❑No Type of Permit Requested(refer to reverse side for explanation of controlled and non-controlled access): ❑ $100 Temporary Controlled Access ❑ $70 Temporary Non-Controlled Access ❑$100 Agricultural Controlled Access ❑ $70 Agricultural Non-Controlled Access ❑$100 Residential(single family)Controlled Access 0 $70 Residential(single family)Non-Controlled Access ,"A $200 Residential,Joint Access> 1 parcel ❑ $200 Commercial,<100 ADT** ❑ 01,000 Private/Public,New/Exisdng,Street or Road ❑j $500 Commercial,>100 and<1,000 ADT ❑ $40 Miscellaneous ❑ $1,000 Commercial,>1,000 ADT **ADT denotes Average Daily Traffic. Data substantiating ADT for access or road intersections may be required. Check or money order In the amount of ,payable to the Dane County Highway and Transportation Department 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 4 I dia \\ Date /O1'27 Q 6 Si gna ture of App lic an epresentative 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 Highway and Transportation Department,2302 Fish Hatchery Road, Madisbn, WI 53713. Contact the Assistant Commissioner at 266-4036 or Engineering office at 266-4037 with any questions. Anv applicants which are denied a permit may appeal the decision to the Dane County Transportation Committee. DO NOT WRITE OR TYPE BELOW THIS LINE--FOR DANE COUNTY USE ONLY P r I APPROV BY DANE COUNTY COUNTY PE ' ' NUMBER: O(oA-OSQ The fo .f_ application is by approved and permit issu Dane County subject to •mpliance by the Applicant with all p ',ions and conditio tated herein and on the reverse hereof and all attachments i. .. Other Special .visions: 4 •ClIS 8 Z7-0?