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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: 3/a6 faa/7 <br /> APPLICANT NAME: /?7 L <br /> APPLICANT ADDRESS: c7 p,5 / /6 '/ 1 • <br /> PHONE NUMBER: q <br /> LOCATION OF DRIVEWAY: OSo 7-0 I d s/61 -7- / <br /> Field Road for Agricultural purposes only <br /> Agricultural Driveway to proposed*/existing Agricultural Blg. <br /> Residential Driveway to proposed building site* <br /> X "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- <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 /> 4,..fowi. :21 n Date d this ✓ day of <.�GI�L--Year of .,20/7 S <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. o KU.)£ `�`4Y 4E6-0 S s�o P� cor�R�cr��r.� At RoAc WA <br /> YES ruf- t42vuN No v <br /> 2. Any corrections in the construction of the Driveway must be completed •y: 6 / 5 /20/7 <br /> APPROVED: x � )�JC{ � � `� 4z,2_0 6-Uct ) <br /> Town Ch an upervisor <br /> DATED THIS g " DAY OF J UAL 1, 7 <br /> .eveor NTYZONING: ZONING PERMIT ST NOT BE ISSUED UNLESS SIGNED BY TOWN <br /> CHAIRPERSON AND SUPERVISOR ABOVE. <br />