DCPZP-2018-00094 - Laserfiche WebLink

Home Browse Search

•• rs . APPLICATION/PERMIT FOR CONNECTION TO STATE TRUNK HIGHWAY Wisconsin Department of Transportation(WisDOT) DT1504 9/2009 s.86.07(2)Wis.Stats.&Ch.Trans 231 Wis.Adm.Code • This form is an application for permission for a STH Connection.If approved,the Document Identification Number permit does not create a right of access or access easement for the property. /3-1002_1/34 7-20/7 • If the property has any legal restrictions that prohibit access to a state trunk highway LL g (STH),WisDOT cannot approve a STH connection permit for the property. O '' Wisconsin DOT • Please type or print neatly in ink. Fill out the required information on both sides of ~O SW Region-Madison Office this form per the instructions.One form is required per connection. For more o LL information,visit: http://wisconsindot.aov/Pages/doing-bus/real- En z 2101 Wright St. estate/permits/default.aspx Madison,WI 53704 • Please provide a copy of the property deed with all applications. 1.Applicant Name and Mailing Address—Street/PO Box,City,State,ZIP Code 2.Property Owner Name/Address(If not applicant) z 14 (ZrY),cttil '40(1, n F ke bark 1'3&A-HI, c/.5 L L- e..... i 2 a 1- o a 10 /v5 -600 5-t ' 3S S 3 s-T4 r3 tl '7v cam/ , ^ ,A� C,9, /tl� GL L.)r .5-1 5-'2,3 Q z C -�' '�'t Q`1 E I �`�r 5--; 5 Z 3.If Not Property Owner,Reason for Application z 4.Highway Number(s) 5.County 6. ❑City ❑Village Town 7.Side of the Highway O � / P 3 `f D A of: I7 e6 R.r, cc.j� ❑ North ❑South ❑East V West 0 0 8.Located within the i 2 9.Fire or Street Number(If applicable) aI 5' Quarter,of theN1 Quarter, Section3�,Town 7 North,Range East — rr IIi 0 10.Name of Nearest Side Road from Location Distance and Direction from Side Road 11.How far is the location from the w z � nearest non-side road connection Z 1J e.--t I-. k e fc, D l U`�`3 �{ ' on the same highway? °2U4 )' o (Feet or Miles) (N,S,E,W) (Feet or Mlles) U Log Mlle or Reference Point(Filled in by WisDOT):,,po) A/.� 1.9 ui a 12. Proposed Activity 13.Proposed Use(Check one—See instructions for category description) 16.Proposed Trips Per Day(Check one) a. z (Check one) (•- o ❑Urban—Commercial/Industrial ❑Rural—Agricultural ❑Seasonal ❑ 101-1000 z p. _ 0 Urban—Residential ❑Public Road 21-50 ❑Over 1000 of Construct New ❑ Rural—Commercial/Industrial ❑Trail or Trail Crossing ❑51-100 ❑Alter Existing o o Er Rural—Residential z'z ❑Remove Existing Peak hour traffic count: o _ Is this a change of the existing use(If applicable)? ❑Yes [�'No o ❑Permit Existing • 14.Proposed Width:4.y 15.Proposed Surface: 2-P0)El-. QUESTIONS 17-27 on BACK PAGE All connections have restrictions,which include the information preprinted The applica affirms that all information provided on and submitted and filled-in on this application along with any conditions, covenants, inco the form Is correct and t in complete. denial or incorrect s supplemental provisions, superimposed notes, and detail drawings added well information prosecution may result in permit denial in revocation as by WisDOT. The applicant shall be responsible for complying with these Well as criminal prosecution under s.946.32 Wisconsin Statutes. restrictions along with the construction and maintenance of the connection. It is further understood that WisDOT's approval is subject to applicant's full - - 3 1, / compliance with relevant state statutes and administrative rules, plus any (Property Owner or Authorized ep = tative) (bate) laws, codes, rules, regulations, ordinances and permit requirements of other jurisdictional agencies.The alteration of this form by the applicant is prohibited. Under s.86.073 Wisconsin Statutes,WisDOT's permit denial or 6o U p 1 3 - ) 2.,'-. revocation may be appealed. (Area Code and Telephone#) (E-mail address if available) FOR OFFICIAL WISDOT USE ONLY—DO NOT WRITE BELOW THIS LINE igi THE FOLLOWING SUPPLEMENTAL PROVISIONS APPLY M Permit APPROVED(THIS PERMIT IS REVOCABLE) Permit DENIED l �r.17 Ut.ii Jo je W;t( ntrLA I rerjoj ❑ Application DISMISSED • 40 , t -f /h•rt,'rrturrI j ra.d-t- - x e ti. /0 20/7 Z 5.e.e- Ck.: c( ;r Gtr`v 1 J j�As' (If Co • Authorized Repre entative) (Dat�) tLC G�� T�" (If Computer-filled,Brush Script Font) ❑Temporary permit.Expiration date: ❑This permit voids/replaces permit# I ® Shared Co-user name: Febock connection Related permit# 13-100243468-2017