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S <br /> TOWN OF PRIMROSE <br /> DRIVEWAY PERMIT APPLICATION <br /> (DANE COUNTY ZO G PERMIT ISSUED ONLY AFTER FINAL INSPECTION BY THE TOWN BOARD) <br /> APPLICATION DATE: , • l • Z6 1 I <br /> APPLICANT NAME: �1 ►� t I I.i, , V 11111 <br /> APPLICANT ADDRESS: ��±•'��e :�\1� � Cj latIn V Y` <br /> PH ONE NUMBER: . ��IN 1-� 6•: 6 , 165 X7'7' <br /> LOCATION OF DRIVEWAY: e 1 II e I l\'.Iit It • 6 hi P211- <br /> Field Road for Agricultural pu ••ses only <br /> /Agricultural Driveway to proposed•I existing Agricultural Big. <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: 44...staale--C.1 <br /> Ig;;*t <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)must 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 /> Waved: <br /> --D OA <br /> The above application is hereby approved by: x ' • i <br /> T•tif Chat r=n <br /> Dated this 1 day of IJ ■ x <br /> Year of j O fl Supervisor <br /> Super <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: / I . <br /> APPROVED: x x <br /> Town Chairman Supervisor <br /> DATED THIS DAY OF , <br /> QgNTY ZONING: ZONING PERMIT UST NOT BE ISSUED UNLESS SIGNED BY TOWN <br /> CHAIRPERSON ANDMJPERVISOR ABOVE. <br /> 5 <br />