Driveway or Access Road Permit

Town of Clover

Driveway or Access Road Permit for Ordinance #20170510-1, Road, Driveway and Right-of-Way Ordinance as Amended 20201111-2

 

An employee or supervisor of the Town of Clover has inspected the site for the property owner named on this permit. The proposed driveway/access road has been approved. All costs or services provided by the Town will be billed to the property owner by the Town Clerk. Culvert size shall be decided by the inspector (minimum size: 24′ long and 12″ diameter). A Permit Fee of $20.00 must accompany the request. A higher fee may be charged if extraordinary circumstances so dictate.

Please print this form and return it with your check payable to the Town of Clover to:

Tracy Gillespey, Clerk, Town of Clover, P.O. Box 94, Herbster, WI 54844

  •  

To be Completed by Town employee, Town of Clover Emergency Services Officer-as indicated-and Town Chair: (Check if met)

  • Provides direct ingress or egress [S4.A.1.]: 󠄁󠄀
  • Provides a minimum of 150 feet of sight distance [S4.A.1.]: 󠄁󠄁
  • Located, as possible, so as not to interfere with existing utilities [S4.A.1.]: 󠄁󠄀
  • Driveway length greater than 100’ from road to principal structure [S4.A.2.]: 󠄀󠄁
    • If length greater than 100’ from road to principal structure, appropriate member of emergency services assessed for proper ingress and egress [S4.A.2.]: 󠄁󠄀 Initials:______
  • Intersection with roadway sloped to preclude ordinary surface water drainage onto roadbed [S4.A.3.]: 󠄀󠄁
  • Driveway apron does not extend into the road further than roadway or pavement edge [S4.A.3.]: 󠄀󠄀
  • No entrances, ditches or roadside areas or existing structures in right-of-way [S4.A.3.]: 󠄁󠄁
  • Driveway and parking areas graded so no storm water discharges onto roadway [S4.A.3.]: 󠄁󠄀
  • If relocation of utilities required, has the Town Board approved relocation or alteration? [S4.A.4.]: 󠄁󠄁
  • If any of above not met, did Town Board approve variance? [S4.A.5.]: 󠄁󠄀
  • If Field Road, Agricultural, Commercial or Industrial Driveway:
    • Angle between centerline of driveway and edge of surface of public roadway not less than 70 degrees [S4.B.1.a.]: 󠄀󠄁
    • If industrial road, meets requirements of S4.B.1.b.: 󠄀󠄀
  • Special Requirements for Residential Driveways:
    • No less than 24’ wide at edge of roadway surface [S4.B.2.a.]: 󠄀󠄁
    • Minimum width of driving surface no less than 14’ [S4.B.2.a.]: 󠄁󠄀
    • Minimum height clearance of 14’ [S4.b.2.a.]: 󠄀󠄁
    • Unobstructed turnaround sufficient to accommodate emergency services vehicles and Town vehicles (grader, dump truck) [S4.B.2.b.]: 󠄀󠄀
    • Angle between centerline of driveway and edge of surface of public roadway not less than 70 degrees [S4.B.2.c.]: 󠄀󠄁
  • Culvert Construction Standards:
    • Installed prior to beginning construction on property [S4.B.3.a.]: 󠄀󠄀
    • Galvanized steel or HDPE? [S4.B.3.a.]: 󠄀󠄁
    • Provides adequate bearing capacity for all vehicles expected to use driveway [S4.B.3.a.]: 󠄀󠄀
    • Minimum size 24’ length & 12” diameter but final specifications to be determined by Town Crew and Town Chairperson [S4.B.3.b.]: 󠄀󠄁
    • Final Specs for culvert in question: [S4.B.3.b.]

                   Length _______feet, Diameter ________inches

  • Placed in ditch line as marked by Town Board as recommended by Town Crew [S4.B.3.c.]: 󠄁󠄀
  • No end walls or abutments of timber, rock or similar material [S4.B.3.d.]: 󠄁󠄁
  • Material compatible with culvert selection [S4.B.3.e.]: 󠄀󠄀
  • At least 6” of cover measured from top of culvert [S4.B.3.e.]: 󠄁󠄁

 

Property Owner agrees to the above conditions:

____________________________________________   ____________________

Signature (Property Owner)                                                                      Date

 

Authorization to Install Culvert and Construct Driveway:

 ____________________________________________   ____________________

Signature (Town Chairperson)                                                                              Date

 

Date of Compliance Inspection: _________________

Inspected by: _____________________________

 

__________________________________________   ____________________

Signature (Town Chairperson)                                                                  Date

___________________________________________   ____________________

Signature (Town Clerk)                                                                                Date

 

 

 

 

Created: 10/14/09   TC/Ordinances/Form Permit Driveway

Revised:  9/14/16;1/24/17;5/11/17;8/6/19; 9/1/20;11/9/20