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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: 34b //�of 7 <br /> APPLICANT NAME: J d././ <br /> APPLICANT ADDRESS: O O5 _Z__� A - / 1 - i <br /> PHONE NUMBER: �3 y� <br /> LOCATION OF DRIVEWAY: pso 7-0�a- - d 591J- 7 <br /> Field Road for Agricultural purposes only <br /> Agricultural Driveway to proposed*/existing Agricultural Big. <br /> )Q 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: <br /> 1. Payment of required Driveway Fee of$250.00 Payable to the Town of Primrose ✓XE C <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)must be in writing and given to the Town <br /> Required YES NO X <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 Ch • a <br /> Dated this 04 day of <br /> Year of .20/7 Superv" or <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. p Ku.) Ay ✓��aS s to Pi: co�ECrcok Ar RoADLOA <br /> YES ruo3 _ARoUN NO Y <br /> 2. Any corrections in the construction of the Driveway must be completed •y: 8 I 8 1 -017 <br /> APPROVED: x 6I fct.,:1, <br /> Town Ch Ch an upervisor <br /> DATED THIS v " DAY OF 0 2-0( 7 <br /> j9 <br /> Reltipf.61IiNTY ZONING: ZONING PERMIT MUST NOT BE ISSUED UNLESS SIGNED BY TOWN <br /> CHAIRPERSON AND-SUPERVISOR ABOVE. <br />