Application For Driveway Permit & Fire Number
Town of Cloverland

 

Date ___________

 

Parcel #: ________  Comp #: ________  Section: _______  T 40 N, R 9 E

Applicant's  Name:  ________________________________________________________

Mailing Address:  ___________________________________________

 

City/Zip:  _________________________________________________

Telephone Number:  __________________­_______________________

 

E-mail Address _____________________________________________

Road Name:  _______________________________________________

Proposed Land Use: __________________________________________

 

Your new Fire Number will be assigned based on the exact point where your parcel's driveway intersects a public or private access road.  This point will be determined based on the location of your nearest neighbors' driveway in both directions.  Please answer the following questions based on the location of your proposed and your neighbors' driveways.

 

1)  Is your current driveway currently existing?  ___ Yes   ____No 

2)  In the north or east direction, my nearest neighbors' driveway is  _______ FEET or _______ MILES from my new driveway, and is located on the SAME  ___ or OPPOSITE  ___ side of the road.  This neighbor's fire number is  _______.


 

 

3)  In the south or west direction, my nearest neighbors' driveway is  _______ FEET or _______ MILES from my new driveway, and is located on the SAME  ___ or OPPOSITE  ___ side of the road.  This neighbor's fire number is  _______.

 

Draw or attach a diagram of the lot showing Public or Private Access Road, Buildings, and driveway(s).

 

 

 

 

 

 

 

 

 

 

  1. Permit fee of $25.00 payable to Town of Cloverland must accompany application if driveway accesses a public road.
  2. No fee is required for access to a private road or for fire numbers.
  3. No permit will be issued until each side of the proposed driveway/s is clearly marked with flags, stakes or spray paint. 
  4. Refer to the driveway ordinance for specific conditions and requirements.
  5. A fire number will not be assigned until a driveway permit has been issued.

 

 

Special Notes: _________________________________________________________

_________________________________________________________

_________________________________________________________

 

 

 

Return completed application and fee to:

Marty Ketterer, Supervisor   715-479-9426   ketterer@townofcloverland.org         

Town of Cloverland

PO Box 1565

Eagle River, WI 54521

 

For Official Use Only:
A culvert (will/will not) be required.  Additional requirements:
_________________________________________________________

 

_________________________________________________________

_________________________________________________________

 

Driveway permit assigned by: _________________________ 

 

Date Assigned:  ________________

Fire Number Assigned:  _____________________________  

 

Date Assigned:  ________________

Fire Number installed by:  __________________                    

 

Date: Installed: ________________

Date Filed:  _______________