RECORD OF UNPERMITTED–NONCONFORMING CONNECTION TO STATE TRUNK HIGHWAY

Wisconsin Department of Transportation (WisDOT)

DT2231 10/2013 s.86.07(2) Wis. Stats.

Property Owner(s) Information / 1. Property Owner(s) Name and Mailing Address
Street/PO Box, City, State, ZIP Code / (Area Code) Telephone Numbers
(optional) / WisDOTOffice
Information / Document Identification #:
______Southwest Region – MadisonSouthwest Region – La CrosseSoutheast RegionNortheast RegionNorth Central Region – Wisconsin RapidsNorth Central Region – RhinelanderNorthwest Region – Eau ClaireNorthwest Region – SpoonerNorthwest Region – Superior
______2101 Wright Street3550 Mormon Coulee Road141 NW Barstow Street944 Vanderperren Way1681 Second Avenue South510 N Hanson Lake Road718 W Clairemont AvenueW7102 Green Valley Road1701 North 4th Street
______Madison, WI 53704La Crosse, WI 54601Waukesha, WI 53187Green Bay, WI 54304Wisconsin Rapids, WI 54495Rhinelander, WI 54501Eau Claire, WI 54701Spooner, WI 54801Superior, WI 54880
Email Address (optional)
Connection Location Information / 2. Highway Number(s) / 3. County / 4. City Village Town / 5. Side of the Highway
of / North South East West
6. Located within the / 7. Fire or Street Number (if applicable)
NENWSESW Quarter, of the NE NWSESW Quarter, Section , Town North, Range
8. Name of Nearest Side Road from Location / Distance and Direction from Side Road / 9.How far is the location from
the nearest non-side road connection on the same highway?
NorthSouthEastWest
(Feet or Miles) (N, S, E, W) / (Feet or Miles)
Log Mile or Reference Point / Property Tax ID Number

CONNECTION TYPE INFORMATION

CURRENT USE / OTHER USE(S) / OTHER DATA / TRIPS PER DAY / CULVERT INFORMATION
Urban – Commercial/Industrial
Urban – Residential
Rural – Commercial/Industrial
Rural – Residential
Rural – Agricultural
Public Road
Trail or Trail Crossing / Recreational
Private Road
Utility
Shared
Emergency
Restricted / Width
Bypass Lane
Median Opening
Median
Right-in, Right-out
Entrance Only
Exit Only
Gated
Pictures Yes No / Seasonal
1–50
51–100
101–1000
Over 1000
Peak hour count
Counts above are
Estimated
Actual / Diameter
18" 30"
21" 36"
24"
# of pipes
Length / Material
None
Metal
Concrete
Plastic
Endwalls
Grates
COMPOSITION / Box Culvert Size
Grass Gravel Asphalt Concrete
Additional Description or Explanation
Reason(s) for Nonconforming Status
WisDOT Project ID, Description, and Stationing (if applicable)

NOTES:

This document records the existence of an unpermitted–nonconforming connection between your property and a state trunk highway as detailed above.

1)WisDOT has determined that the connection was legally in existence, but does not meet the requirements of current law, standards or policy. The connection does not have a WisDOT permit, and cannot be permitted as it exists today.

2)WisDOT may alter, relocate or remove the connection as part of a highway improvement or maintenance project at WisDOT’s expense.

3)If WisDOT does not perform the actions listed in #2, the connection will be allowed to remain as is unless WisDOT documents a safety or operational problem.

4)A property owner shall maintain the connection, which includes snow and ice removal, minor surface repairs or sealing, culvert cleaning, etc.

5)WisDOT requires the submittal of DT1504 Application/Permit for Connection to State Trunk Highway when any of the following are proposed:

  1. Altering (widening, paving, replacing a culvert, etc.) the connection
  2. Changing the connection’s existing use. “Change of Use” means any modification to a property that results in a change in the number and/or types of vehicles using a property’s connection. Examples include changing from residential to commercial use, changing from single to multiple residential use, changing the type of business, and subdividing the property to accommodate additional residences or businesses as described in s. 236.12, Wisconsin Statutes.
  3. Removing and relocating the connection

None of the actions in #5 shall be done unless the connection is also brought into compliance with current law, standards and policy. Exceptions may be allowed in rare circumstances.

Additional Notes: / X
(WisDOT Authorized Representative)
(If computer-filled, Brush Script Font) / (Date – m/d/yyyy)

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