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17. ®Yes ❑ No Is the property zoned? Provide documentation from the jurisdictional zoning authority. <br /> 18. Explain how the land is currently being used: Agricultural <br /> 19. ®Yes ❑ No Are you aware of any plan to change the zoning or land use <br /> for the property? If yes,explain. Splitting off a small residential lot to build a new home <br /> 20. ❑Yes ❑ No Is this connection for property that was part of a land division <br /> or assemblage created on or after 2/1/99? If yes,explain. New CSM <br /> 21. ❑Yes ® No Do you own other property abutting the highway that is next to <br /> the property that this connection will serve? If yes,describe. <br /> Note 1: Answering"yes"to#20 or 21 may result in a Wis. <br /> Administrative Code Trans 233 review by WisDOT.If this is <br /> needed, the processing of your application maybe delayed. <br /> 22. ❑Yes ® No Does the property abut or border another public road? If yes, <br /> provide the road's name. <br /> 23. ❑Yes ❑ No Are there any existing connections serving the property? If yes, how many? 1 <br /> 24. ❑Yes ❑ No Are there any restrictions on the number,use,or location of connections to the property? <br /> 25. ❑Yes ® No Are there any access easements across the property(recorded or unrecorded)? <br /> Note 2: If you answered"yes"to#24 or 25, provide a copy of <br /> all documents relevant to the restrictions and/or easements <br /> 26. Provide the property tax identification number: 091234195002 <br /> 27. What is the proposed construction completion date for the connection? See Conditions of Issuance#9. December 31, 2021 <br /> FOR ANY NEW CONNECTION OR CONNECTION TO BE MOVED, APPLICANT SHALL PLACE A FLAG OR MARKER IN THE <br /> HIGHWAY DITCH OR FORESLOPE (VISIBLE FROM THE HIGHWAY)AT THE PROPOSED LOCATION. <br /> CONDITIONS OF ISSUANCE <br /> 1. WsDOT reserves the right to make such changes,additions,repairs,relocations and removals within statutory limits to the connection or its appurtenances on <br /> the right-of-way as may at any time be considered necessary to facilitate relocation, reconstruction, widening, and maintenance of the hig hway, or to provide <br /> proper protection to life and property on or adjacent to the highway,or if alternative access to the property becomes available. <br /> 2. Except in cases where the indicated connection may be constructed by forces acting on behalf of WsDOT due to a highway improvement or maintenance <br /> project,the permittee shall do all of the following: (a)Furnish all materials,do all work, and pay all costs for the construction and maintenance of the connection <br /> and its appurtenances on the right-of-way.Materials used and the type and quality of the work shall be appropriate for the connection type specified in this permit; <br /> (b) Do all work without jeopardy to, or interference with, traffic using the highway; (c) Promptly restore to WisDOT's satisfaction and at least pre-existing <br /> conditions,highway surfaces,shoulders,ditches,vegetation,drainage appurtenances,guardrail,signs,electric conduits/cables,etc.disturbed by any work; (d) <br /> Maintain the connection and its appurtenances within the right-of-way limits,which includes keeping them in a proper state of repair, preventing the blockage or <br /> impairment of right-of-way drainage,and preventing aboveground obstacles to occur that could cause serious injury or death to a motorist in an errant vehicle; (e) <br /> Not disturb or cause the disturbance of any survey marker without the prior written approval of W1sDOT. <br /> 3. The permittee,indicated on the reverse side, represents all parties in interest,and agrees that any connection or approach constructed by or for the permittee <br /> is for the purpose of obtaining access to the property (listed in #26) and not for the purpose of parking or servicing vehicles, or for advertising, storage, or <br /> merchandising of goods on the right-of-way. <br /> 4. The permittee shall not make any changes to the connection,its appurtenances,or adjacent right-of-way,including,without limitation,changes to the location <br /> (#4-11),use(#13),width(#14),surface(#15),or increase the number of trips per day(#16)approved by this permit without obtaining prior written approval from <br /> W1sDOT.WsDOT will evaluate all potential highway impacts that may arise from the proposed change(s)and therefore,does not guarantee approval. <br /> 5. The permittee, successors or assigns agree to hold harmless the State of Wisconsin and its duly appointed agents and employees against any action for <br /> personal injury or property damage sustained by reason of the exercise of this permit. <br /> 6. WisDOT does not assume any responsibility for the removal or clearance of snow,ice or sleet,or the opening of windrows of such material upon any portion of <br /> any connection along any state trunk highway even though snow, ice or sleet is deposited or windrowed on said connection by its authorized representative <br /> engaged in normal winter maintenance operations. <br /> 7. Under Wisconsin Administrative Rule Trans 401,the permittee shall implement proper erosion control and storm water management measures at all times <br /> during work operations and upon completion of the connection to protect all restored areas until the replacement vegetation achieves sustained growth. <br /> 8. Rock,asphalt,concrete,timber or other embankment retention or marking treatments for the connection are prohibited. <br /> 9. If the permitted work has not been started by the construction completion date,this permit is null and void.If the work has been started but is not finished by <br /> the construction completion date, no additional work shall be done unless authorized through an approved written time extension or a subsequent permit from <br /> WisDOT.Accomplishment of any part of the work shall verify agreement by the permittee to conform to this permit and to be bound by all of its requirements, <br /> restrictions,and obligations,all of which shall continue to be in full force and effect. WsDOT does not guarantee the approval of a time extension or subsequent <br /> permit since the conditions WisDOT based its permit approval upon may have changed between the permit approval date and time extension request date. <br />