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 .
ACTION REQUESTED BY APPLICANT
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 ___________
PROVIDE THE FOLLOWING ADDITIONAL INFORMATION AS IT APPLIES TO YOUR APPLICATION
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