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).

NOTE: No driveway permit will be issued until each side edge of the proposed driveway is clearly marked with flags, stakes or spray paint. Refer to the driveway ordinance to specific conditions, dimensions, and requirements.

Driveway permits are not required if the drive accesses a private road.

A fire number will not be assigned until a driveway permit has been issued.

Special Notes: _________________________________________________________

_________________________________________________________

_________________________________________________________

Return completed application 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:  _______________