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TOWN OF PRIMROSE <br /> DRIVEWAY PERMIT APPLICATION <br /> (DANE COUNTY ZONING PERMIT ISSUED ONLY AFTER FINAL INSPECTION BY THE TOWN BOARD) <br /> APPLICATION DATE: 07///7 <br /> APPLICANT NAME: Alike O/ I U / i/4 I'M-- <br /> ADDRESS: 3 1 <br /> • e 5 ,tke€ S-35 9 <br /> PHONE NUMBER: 6d p— A210 s-CO v U j 7 <br /> LOCATION OF DRIVEWAY: �Q p <br /> Field Road for Agricultural purposes only <br /> Agricultural Driveway to proposed*/existing Agricultural Blg. <br /> Residential Driveway to proposed building site* <br /> *Building site approval form attached to this document <br /> Applicant agrees with the following requirements of the Town of Primrose Driveway Ordinance and application. <br /> APPLICANTS SIGNATURE: I°a 4rAi eyttpA.in a(fle r f! 042,4`""`'f <br /> v ' <br /> 1. Payment of required Driveway Fee of$250.00 Payable to the Town of Primrose <br /> 2. Payment of required Driveway Bond Fee of$500.00 that is refundable upon completion and approved inspection of the <br /> Driveway. <br /> (refund is made assuming no damage is done to the Highway fronting the drive) <br /> 3. Erosion Control Plan(during construction) Wst be in writing and given to the Town <br /> Required YES NO <br /> 4. Engineering Plan(prior to construction)must be in writing and given to the Town <br /> Required YES NO <br /> 5. Specifications of the Driveway Construction,as denoted in the Driveway Ordinance if Waived,which items of(a)through(p). <br /> Waived: <br /> The above application is hereby approved by: x <br /> Town Chairman <br /> Dated this day of x <br /> Year of Supervisor <br /> x <br /> Supervisor <br /> Town Board Inspection of Completed Driveway <br /> 1. Driveway is constructed in accordance with the applicant's 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 /> APPROVED: x x <br /> Town Chairman Supervisor <br /> DATED THIS DAY OF <br /> eTRAIRFRINNTY ZONING: ZONING PERMIT MUST NOT BE ISSUED UNLESS SIGNED BY TOWN <br /> CHAIRPERSON AND S16IPERVISOR ABOVE. <br />