LOCATION: ____________________________________________________________________

                                    

PROPERTY OWNER:   ___________________________________________________    PHONE:  ________________________________

Email address:  __________________________________________________________

OWNER OR AGENT IS REQUESTING PERMIT FOR: (Check all that apply)

______ New Culvert or replacement of old culvert.  ($50 FEE)

______ Paving driveway or apron  ($50 FEE )   NOTE: If paving and installing a new culvert at same time only one $50 fee required.)

______ New address number for this location. ($100 FEE)

PROVIDE INFORMATION ABOUT CONTRACTORS WORKING ON SITE WHEN APPROPRIATE:

COMPANY:  __________________________________________________________________________________________________________________

ADDRESS:  _______________________________________________________________  PHONE:  ________________________________________

NOTE: You must provide the following information for an address application:

TAX PARCEL NUMBER REQUIRED:        _______________________________________

IF IN A SUBDIVISION PROVIDE the NAME OF THAT SUBDIVISION:  _________________________________________________

PROPERTY DRIVEWAY WILL EXIT TO WHAT ROAD: ___________________________________________ 

IF A CULVERT IS NOT ALREADY IN PLACE AT THIS LOCATION the APPLICANT WILL NEED TO CLEARLY MARK WITH A STAKE OR FLAG WHERE THE ENDS OF THE CULVERT WILL BE LOCATED.

Your signature indicates you agree to comply with requirements specified below for this permit.

Applicant Signature:  ______________________________________________________________   Date:  _________________________

    (Permit valid for one year after issue.)

CULVERT AND APPRON permits will be issued subject to the following general conditions:

1.Installation to be made without danger to, or interfering with traffic on roadway.

2.Applicant, assignees agree to hold harmless the Town of Kaukauna and duly appointed agents and employees against action for personal injury or property damage sustained by reason or exercise of this permit.

3.The proposed construction or actions will conform to the statutes of the State of Wisconsin and regulations of any legally constituted body having jurisdiction.

4.The Town of Kaukauna reserves the right to make changes, additions and relocations within statutory limits in the right of way as may at any time be considered necessary to permit the relocation, reconstruction, widening and / or maintaining of the roadway to provide proper protection to life and property.

5.Roadway surface, slopes, shoulders ditches and vegetation disturbed shall be restored.

6.The entire cost of installing and maintaining of items requested by this permit shall be borne by the applicant and shall be performed at the sole cost and expense of the applicant.

7.Work shall be carried out using good municipal engineering practices in a manner satisfactory to the Town of Kaukauna Board or their representatives.

8.No work shall start until warning signs and /or devices are placed to protect the public that must conform to the Wisconsin Department of Transportation requirements for traffic control. Such devices shall be maintained as necessary to protect persons or property at all times and under all conditions until work is completed.

9.Erosion control practices must be in place and maintained until vegetation is stabilized when doing work in ditches and Town right of way.

Specific culvert and apron requirements for connection to a Town roadway :

1.Culverts shall be new with apron end walls.

2.Culverts shall be of a size designated to allow for the water flow design for that location.

3.Aprons shall be the full width of the culvert.

4.Aprons shall only be of bituminous material.

5.IMPORTANT NOTE:  Aprons shall be designed to direct surface water from a driveway from spilling onto the roadway. Water needs to be directed to ditches, to designed rain gardens or French drains that comply with Department of Natural Resources regulations for erosion and storm water management.

6.Side slopes at end walls shall not be covered by concrete barriers, rocks or any other materials which may inflict harm to vehicles (including recreation vehicles)  that could come in contact with these areas.

7.Bituminous side slopes, natural vegetation and landscape stone under one inch are allowed to be used to prevent soil erosion at end walls.

8.Engineered drawings are only required for commercial roadway access points or any residential access points that might impact protected areas such as rivers, streams, wet lands or require special construction because of soil type.

9.Driveways at new residential construction must comply with erosion control requirements as specified in SPS 321.125 in the Wisconsin Uniform Dwelling Code. 

MORE INFORMATION available at the following State WEB site: https://docs.legis.wisconsin.gov/code/admin_code/sps/safety_and_buildings_and_environment/320_325/321/III/125

IMPORTANT NOTE:    Be advised you are required to get an Outagamie County Storm Water Permit if the hard surface of the drive and roof area of the home exceed 2000 square feet.  For more information contact Outagamie County Zoning Department: 920-832-5255

ADDRESS REQUEST

Address numbers are assigned by a specific formula that complies with electronic mapping and GPS systems.  The assignment starts with your request to the Town for a new address.   Once the Town receives your application the town building inspector will review application and request  that a number be assigned by Outagamie County. When that is received he will notify the Town Clerk and ask the town to order the sign that will be placed at your site by the Town Fire Department.  Although we may be able to get you information on what the number will be assigned in a reasonable amount of time, the actual placement of the address sign may take several weeks.

       SEND APPLICATION and make FEE check payable to:  

     Tom Smith Inspections LLC

                  2740 Otto Court

               Green Bay, WI 54313