Send to:    Tom Smith Inspections LLC        2740 Otto Court     Green Bay   Wisconsin    54313

Be aware that a new ordinance was enacted  December 1, 2022 by the town board (Ordinance 2022-01 )  that now requires  any new private road or any road construction to an existing town road,  street or highway shall be approved by the town .


Requesting permit for a new driveway and  new culvert in the roadway setback.   (yes )    (no)    Fee $ 75

Requesting permit to move or repair culvert in the roadway setback.     (yes )    (no)     Fee $ 75

Requesting emergency address using an existing culvert onto town road.    (yes )    (no)   Fee $ 75

Requesting an emergency address number for a new culvert and drive way onto town road.   (yes )    (no)  Fee$ 150

Is this a shared driveway  (yes )  Note: Only three dwellings can share  same driveway.)  (no)


               —— (                   )——————————————flow line for ditch — [Culvert location]————————                                  

                                                                                                            Road  name: ____________________________

Use arrow to show water flow direction in ditch.

Nearest address to left when facing property.___________

 Nearest address to right when facing property.  ________________

Use arrow to indicate north.  (                     )

Town of Peshtigo Culvert and Driveway construction Permits

Owner: ____________________________  Mailing Address   ________________________________________

Phone: _______________________  email _________________________________________ Date ___________


1. Proposed culvert material:           _____  concrete  ______PVC material approved for culvert applications  ____  metal

                Used culverts not allowed  without special approval.

2. Driveway length from principal structure or other main building to roadway.   _____ feet.

3. A 25 foot in length by 18 foot width segment will  be placed at each 200 feet of driveway length to provide passage of  meeting emergency vehicles.      ____ yes   ____  no  when driveway is less than 200 feet to roadway.

4. Will a minimum 12 foot  wide driveway  be maintain to provide clearance for emergency vehicles for the full length?  

        ___yes   ____  no  (Provide details if answer is no.)  

5. Will a minimum height clearance of 18 feet be free of tree limbs and utility wires  and be maintained for length of driveway?

       ___yes   ____  no (Provide details if answer is no.)  

6. Driveway width   ______ feet.    Plus at least 2 feet wider at each end than driveway  for total culvert length of ______ feet    

7. Culvert will  be placed at ditch line flow elevation with 2 to 5% slope. _____ yes   ____  no (If no provide details)

8. Backfill material will be at least 6 inches or culvert manufacturer recommendation. (Must support emergency vehicles.) ____ yes  ____ no

9. Proposed backfill material for this application.  ____ stone or gravel  _____   sand or topsoil   ____ clay

10. Will driveway be paved?  ____No  ______ asphalt  _____ concrete

11. Will driveway apron in the road right of way be paved ? ____No  _____ asphalt  ____ cement

(Note that if cement it will not be replace by municipality if it needs to be removed for road or utility work. )

12. Driveway will be greater than 5 feet from a lot line.  ___yes   ____  no (Provide details if answer is no.)  

13. Will 2 foot culvert end walls be installed. ___yes   ____  no (Provide details if answer is no.)  

14. To your knowledge has water flooded over roadway at this location? __ yes ( Provide details ) ____No  ____Unknown