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• Zoning classification of the subject property <br /> Number of feet from intersections of any town/town or town/county roads: <br /> Other requirements: <br /> 1. Finished accesses must remain at, or below,the grade of the roadway edge for a minimum of ten <br /> feet. <br /> 2. Access base shall be in place prior to the start of construction and all vehicles entering the property <br /> shall use the access to protect the roadway edge. <br /> 3. In the event a culvert is required, said culvert shall be covered by sufficient material to protect it <br /> from the weight of vehicles using the access. <br /> 4. Placement and maintenance of culvert is the responsibility of the property owner. <br /> 5. All dimensions and construction of accesses will adhere to Dane County and Town of Pleasant <br /> Springs standards and ordinances. <br /> 6. Nothing may be placed in the public right-of way except legally constructed mailboxes. <br /> 7. The Property owner is responsible for damage to road edge caused by demolition and/or <br /> construction. <br /> **Once the project is completed please contact(office staff will indicate appropriate contact below): <br /> Town Building Inspector at 608-445-9715 for inspection and issuance of occupancy permit. <br /> The Public Works Department at 608-205-9169 for completion certificate. <br /> ACKNOWLEDGEMENT: <br /> As owner of the above named property, I acknowledge and agree that I am responsible for all damages I cause, <br /> or caused by any contractor or agent retained by me,to the roadway, shoulder, or right-of-way that occurs as a <br /> result of the demolition and/or construction process, including damage caused by equipment traveling to the <br /> work site,up to and including such time as an occupancy permit and/or completion certificate from the TOPS <br /> Building Inspector or Public Works Staff is issued and received by the Clerk. I also acknowledge I am <br /> responsible for ensuring driveway access meets all applicable standards and conditions. I agree that the damage <br /> deposit of$1000.00 will be deposited and retained by the town until the Town Board acts to release the deposit. <br /> Costs for any damage, as well the cost to bring driveway access into compliance with standards and conditions, <br /> determined solely by the Town Board,will be deducted from the deposit prior to return. I understand that no <br /> deposit will be returned until: <br /> a. An Occupancy Permit has been issued by the Town of Pleasant Springs Building Inspector, or <br /> b. A Completion Certificate has been issued by the Public Works Staff, and <br /> c. The Town Board acts to approve the release of all, or a portion of,the deposit and requests a check to <br /> be issued to the property owner. <br /> If the damages exceed the damage deposit, I agree to promptly reimburse the Town upon receipt of an invoice <br /> detailing same. I agree that unpaid amounts will accrue interest at a rate of 1.5%per month. <br /> Property Owner Signature / Date <br /> Approval of initial access <br /> —/ 7 <br /> Town Re resentative Date <br /> - Date Deposit Returned by Treasurer: <br />