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TOWN OF DUNN PARCEL #: 28-0610- ,2 J - �'t'2l/) —3 <br /> DRIVEWAY CONSTRUCTION PERMIT APPLICATION PERMIT #: � J <br /> 1 <br /> SECTION 1 - SITE VERIFICATION•Applicant Name: ‘I:,„, „ t\, ■■C r,,-.,■ ..,A; c,.., Date: 314.9//$T <br /> Address: �,_” %r't� F (- ± .4 l i e N,. Phone#: <- 1i l 7-04 <br /> Purpose: ( ,`Residential ❑ Field Road Access ❑ Other <br /> (Bldg. site verification not required) , 1 <br /> Property Owner's Name: �`t i i G-LI fej D )Ji lS t) b it1 iii 1„40 �'" �r,VA N e_,TT <br /> Proposed Driveway Location: a2C`/3 t(?' 1 /\J % j: <br /> Esc' /37 1 ) V£lip `r• <br /> Driveway will provide access to: ❑ US/Co. Hwy Permit# Town Rd. ❑ Private Rd. <br /> Does property owner own proposed driveway road frontage?'yes ❑ no (If no, attach copy of easement.) <br /> Bldg.Site Verification Date Comments <br /> SECTION 2 -SUBMITTAL REQUIREMENTS& CONSTRUCTION COMMENCEMENT APPROVAL <br /> Driveway Construction Permit Application must include the following checked information: <br /> Diagram Showing: Other: <br /> ❑ Property slopes. ❑ Copy of any required Dane Co. erosion control plan. <br /> ❑ Driveway slope. ig Other <br /> ❑ Driveway turnaround. <br /> ❑ Location& structure of retaining walls. <br /> ❑ Length,width&radius of driveway curves. <br /> ❑ Driveway cross section showing depth&fill material. <br /> ❑ Drainage culvert, ft. length, in. diameter. <br /> ❑ Driveway relationship to property lines, structures&roads. Center of driveway feet from <br /> The undersigned applicant as owner, or as owner's agent, does hereby attest that all the information provided is true and <br /> accurate and-does hereby agree to construct the described work in accordance with the plans and specifications filed. <br /> 11 i <br /> i r ! ►e°� <br /> • <br /> Signature of Applicant Date <br /> P31ic Worleman Initial Construction Approval Date Permit Issued Permit Fee <br /> 4 j, y r} <br /> SECTION 3 - FINAL APPROVAL <br /> ❑ The Town of Dunn has inspected the above field road and determination has been made that it meets <br /> the Town's minimum standards. The field road is authorized for agricultural use. <br /> ❑ The Town of Dunn has inspected the above driveway and determination has been made that the <br /> driveway meets the Town's minimum standards. The Dane County Zoning Office is hereby authorized <br /> to issue a building permit this day of , <br /> Signature of Public Works Foreman <br /> White - Town Yellow - Applicant Pink -Dane Co. Zoning <br />