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DATE:I 1-`1 •I- <br /> I.CONTACT INFORMA,T O -To be Completed Applicant: <br /> Name and current address ,IC Ilene_'_ }'j„(.Ik(a I <br /> of applicant + J p <br /> 4 iII 7 <br /> Current telephone number:work c_. - 1. ' 7-1 <br /> homeld N ?) 11). <br /> •Driveway location in Cross Plains: -4221'le 1 I\ Qc j <br /> Location: west e t south north side of Sec. <br /> Parcel number: �dT 4-. -- ci 22U— (� -i-nj) 02O JOl01-143- ' 10.5 L <br /> Contact Town Chairman,#798-0189,to arrange a site visit. <br /> Please attach a drawing of the driveway location discussed at the site visit and return to the Town <br /> of Cross Plains,3734 County Road P,Cross Plains,WI 53528,Phone (608)798-0189 <br /> as soon as possible after the site visit. <br /> H. CONDITIONS-To be completed by Town Board member or its agent: A <br /> Width of driveway: feet Maximum grade of 12%. � � ' <br /> Drainage culvert needed} no yes tiA 4 i <br /> •I �� <br /> If culvert required,must meet Driveway Construction Guide standards. <br /> Agricultural use only:__._no yes <br /> Shared driveway agreement required: no es I, <br /> go <br /> Other requirements: <br /> 1.Shall comply with town private road ordina ce and driveway construction guide for new <br /> driveways. <br /> 2.Shall contact Town Patrolman before starting construction of the driveway. <br /> 3.No Town Building Permit or Dane County Zoning Permit shall be issued until Driveway <br /> Permit Part 1 AND Part 2 has been issued. <br /> 4. <br /> ************************************************* ** ************** *** <br /> HI.APPROVAL-Date Approved By Town Board. Dike Issued: * \V'fj V. <br /> A The Driveway Permit is valid for one year from date of appr val. <br /> The Driveway Permit is pending recordation of the Certified Survey Map at Dane Coun s <br /> Register of Deeds • <br /> Permit: Part 1 Driveway Permit Part 2 Single Residence d$200.00 Fee / 1)' .t.' v40, <br /> Reminder:Dane County Erosion Control Standards may apply. r <br /> • <br />